ciclesonide and Osteoporosis

The purpose of this review is to compare and contrast the newer inhaled corticosteroid (ICS) ciclesonide with older ICSs in terms of pharmacodynamic and pharmacokinetic properties and how these affect comparative efficacy. In addition, clinical dosing strategies for ICSs including as-needed use will be explored.. Ciclesonide has demonstrated similar efficacy to that of fluticasone propionate and mometasone furoate in equipotent doses with a potentially improved therapeutic index. Once-daily administration of ICSs is generally not as effective as twice-daily. Continuous administration of ICSs does not change the natural history of asthma in either children or adults. Long-term administration of medium dose ICSs does not increase the risk of cataracts or osteopenia in children and young adults. Studies of as-needed ICSs in mild persistent asthma in adults and children have demonstrated mixed results, with some showing equal efficacy to continuous therapy and others showing superiority of continuous therapy.. Ciclesonide provides a newer ICS with favorable pharmacokinetics that may improve the therapeutic index, but assessment of its systemic effects such as growth await further studies. Continuous administration of ICSs in low to medium dose over many years is well tolerated. The use of as-needed ICSs in patients with mild persistent asthma is promising as a potential step-down therapy but awaits further studies.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adrenal Insufficiency; Adult; Aerosols; Anti-Asthmatic Agents; Asthma; Cataract; Child; Dose-Response Relationship, Drug; Drug Interactions; Growth Disorders; Humans; Infant; Nebulizers and Vaporizers; Osteoporosis; Powders; Pregnenediones; Young Adult

Asthma is a complex disease of the respiratory tract associated with chronic inflammation in which an intricate network of cells and cellular factors plays a major role. Asthma is one of the most common chronic diseases, with an estimated 300 million cases worldwide, imposing a considerable burden on society in morbidity, quality of life, and healthcare costs. Inhaled corticosteroids (ICSs) form the gold standard, first-line therapy in the effective management of persistent asthma and reduce morbidity and mortality from asthma. However, long-term use of high-dose ICS therapy has potential to cause systemic side effects-impaired growth in children, decreased bone mineral density, skin thinning and bruising, and cataracts. Hypothalamic-pituitary-adrenal-axis suppression, measured by serum or urine cortisol decrease, correlates with the occurrence of systemic side effects of high-dose ICSs. Therefore, cortisol may be a relevant surrogate marker to identify the potential for adverse effects from ICS therapy. Ciclesonide is a new generation ICS with demonstrable safety and efficacy in the treatment of asthma. The unique pharmacologic characteristics of ciclesonide, such as reduced local adverse effects, lack of cortisol suppression, and the option for once-daily dosing, may improve compliance with therapy and allow long-term use of ICSs without fear of systemic adverse effects.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adrenal Insufficiency; Adult; Anti-Allergic Agents; Asthma; Bone Density; Cataract; Child; Child Development; Contusions; Glaucoma; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Osteoporosis; Pituitary-Adrenal System; Pregnenediones; Skin Diseases