Comparison of the efficacy of ciclesonide with that of budesonide in mild to moderate asthma patients after step-down therapy: a randomised parallel-group study.
BACKGROUND
Inhaled corticosteroids (ICSs) are widely used in asthma control. Ciclesonide (CIC) is an ICS with on-site lung activation for potent anti-inflammatory activity.


OBJECTIVE
This study aimed to compare the clinical benefit of CIC with budesonide (BUD) in step-down therapy.


METHODS
A total of 150 patients with mild-to-moderate asthma well controlled by a combination of ICS and long-acting β2-agonist were randomised to receive either CIC 320 μg (n=75) once daily or 2 inhalations of BUD 200 μg (n=75) twice daily for 12 weeks. The forced expiratory volume in 1s (FEV1), maximum mid-expiratory flow (MMEF) and asthma control test (ACT) scores were measured. Ranked stratification of patients and physicians was assessed.


RESULTS
Drug adherence was significantly higher in the CIC group than in the BUD group (76.0% vs. 58.7%, P=0.03). The FEV1 and MMEF remained stable throughout the 12-week CIC treatment. In the BUD group, FEV1 significantly decreased at weeks 4 and 12. MMEF had a higher value in the CIC group than in the BUD group. Both patients and physicians ranked CIC over BUD.


CONCLUSIONS
CIC is more effective and has better drug adherence than BUD as step-down treatment when asthma is well controlled by combination therapy.
Division of Chest, Department of Internal Medicine, Poh-Ai Hospital, Luodong, Taiwan.
Kuo-Chin
KC
Chiu
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Yen-Li
YL
Chou
Division of Chest, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Jeng-Yuan
JY
Hsu
Department of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan.
Ming-Shian
MS
Lin
Department of Chest Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Ching-Hsiung
CH
Lin
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
Pai-Chien
PC
Chou
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
Chun-Liang
CL
Chou
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
Chun-Hua
CH
Wang
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
Han-Pin
HP
Kuo
D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D019819:Budesonide / Q000627:therapeutic use*; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017060:Patient Satisfaction; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D011282:Pregnenediones / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D018927:Anti-Asthmatic Agents; D011282:Pregnenediones; D019819:Budesonide; C120481:ciclesonide