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Evidence summaries

Ciclesonide for Chronic Asthma

Ciclesonide improves lung function and symptoms in chronic asthma compared to placebo, at least in the short term, and it is an equivalent therapy to other inhaled corticosteroids at similar nominal doses. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 18 group comparisons with a total of 6 343 subjects, of whom 1 692 were children. At doses of 100 mcg/d or less up to 400 mcg/d in mild to moderate asthma, ciclesonide improved lung function, asthma symptoms and rescue inhaler use, compared with placebo. Due to the short duration of the included studies there were insufficient data on the impact of ciclesonide on asthma exacerbations. Comparisons of 100 versus 200 mcg/d, 100 versus 400 mcg/d and 400 versus 800 mcg/d did not yield significant differences in lung function outcomes. Adverse event data were insufficient to permit assessment of the safety profile of the drug.

Another Cochrane review 2 (abstract , review [Abstract]) comparing ciclesonide with other inhaled steroids for chronic asthma included 21 trials with a total of 7 243 subjects, of whom 1 664 were children. Equal daily doses of ciclesonide and beclomethasone (BDP) or budesonide (BUD) gave similar results for peak expiratory flow rates (PEF), although forced vital capacity (FVC) was higher with ciclesonide. Data on forced expired volume in one second (FEV1) were inconsistent. Withdrawal data and symptoms were similar between treatments. Compared with the same dose of fluticasone (FP), data on lung function parameters (FEV1, FVC and PEF) did not differ significantly. Paediatric quality of life score favoured ciclesonide. Candidiasis was less frequent with ciclesonide, although other side-effect outcomes did not give significant differences in favour of either treatment. With lower doses of ciclesonide the differences with other inhaled steroids did not reach significance.

A Cochrane review [Abstract] 3 included 6 studies with a total of 3 256 children (aged 4 to 17 years). The studies compared ciclesonide with either budesonide or fluticasone in chronic asthma. After three months of treatment with ciclesonide compared to budesonide or fluticasone, no relevant differences could be found on asthma symptoms, exacerbations or side effects.

    References

    • Manning P, Gibson PG, Lasserson TJ. Ciclesonide versus placebo for chronic asthma in adults and children. Cochrane Database Syst Rev 2008 Apr 16;(2):CD006217. [PubMed]
    • Manning P, Gibson PG, Lasserson TJ. Ciclesonide versus other inhaled steroids for chronic asthma in children and adults. Cochrane Database Syst Rev 2008 Apr 16;(2):CD007031. [PubMed]
    • Kramer S, Rottier BL, Scholten RJ et al. Ciclesonide versus other inhaled corticosteroids for chronic asthma in children. Cochrane Database Syst Rev 2013;(2):CD010352. [PubMed]

Primary/Secondary Keywords