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. 2009 Feb 25:2:25-32.
doi: 10.2147/jaa.s4651.

Ciclesonide: a safe and effective inhaled corticosteroid for the treatment of asthma

Timothy J Schaffner  1 , David P Skoner
Affiliations

Ciclesonide: a safe and effective inhaled corticosteroid for the treatment of asthma

Timothy J Schaffner et al. J Asthma Allergy. .

Abstract

Ciclesonide is a novel inhaled corticosteroid used in the continuous treatment of mild-to-severe asthma. Its formulation and mechanism of action yield a low oral and systemic bioavailability, and high pulmonary deposition. In multiple clinical trials, ciclesonide is at least as effective as either fluticasone propionate or budesonide at symptom control, while in many cases having improved safety outcomes and tolerability. The improved safety and comparable efficacy profiles of ciclesonide demonstrated in current studies could potentially yield a treatment option that may lead to improved adherence and outcome.

Keywords: asthma; ciclesonide; inhaled corticosteroid.

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Figures

Figure 1
Figure 1
Molecular structure of ciclesonide and its activated metabolite, desisobutyryl-ciclesonide (des-CIC). Christie P. Ciclesonide: A novel inhaled corticosteroid for asthma. Drugs Today (Barc). 2004; 40(7):569–576. Copyright © 2004 Prous Science, S.A.U. All rights reserved.
Figure 2
Figure 2
Intracellular activation of ciclesonide and reversible esterification of desisobutyryl-ciclesonide (des-CIC). Ciclesonide is activated by intracellular esterases to active metabolite, des-CIC, which has high affinity to the glucocorticosteroid (GCS) receptor. Desisobutyryl-ciclesonide can undergo reversible esterification to des-CIC oleate (fatty acid ester). Reprinted with permission from Nave R, Meyer W, Fuhst R, Zech K. Formation of fatty acid conjugates of ciclesonide active metabolite in the rat lung after 4-week inhalation of ciclesonide. Pulm Pharmacol Ther. 2005;18:390–396. Copyright © 2005 Elsevier.
Figure 3
Figure 3
Subjects in all cohorts (CIC40, CIC160, placebo) achieved virtually the same growth velocity during one year of continuous CIC treatment. Reprinted with permission from Skoner DP, Maspero J, Banerji D, and the Ciclesonide Pediatric Growth Study Group. Assessment of the Long-term Safety of Inhaled Ciclesonide on Growth in Children with Asthma. Pediatrics. 2008 Jan;121(1):e1–14. Copyright © 2008 American Academy of Pediatrics.
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