Efficacy and safety of high-dose ciclesonide for the treatment of severe asthma

Abstract

Asthma severity is classified according to the level of treatment required to control symptoms. Inhaled corticosteroids are the recommended first-line therapy for the treatment of persistent asthma, and when asthma remains uncontrolled, one option is to increase the inhaled corticosteroids dose. However, there is a concomitant risk of increasing local and systemic adverse events, which may impact patient adherence and physician prescribing practices. Ciclesonide is delivered as a prodrug, has high peripheral lung deposition and high protein-binding capabilities, and is rapidly eliminated from the systemic circulation. This article reviews the use of high-dose ciclesonide in patients with severe asthma and considers whether the pharmacology of ciclesonide translates into it being an efficacious and well-tolerated option for patients requiring a step-up in their asthma treatment.

Keywords::

• adverse event
• asthma
• ciclesonide
• exacerbation
• HPA axis
• inhaled corticosteroid

Acknowledgments

Editorial assistance was provided by Synergy Vision, London, UK, on behalf of Takeda Pharmaceuticals International GmbH. Takeda was given the opportunity to review the final version of the manuscript and provided comments. However, consideration of these comments remained at the full discretion of the author.

Financial & competing interests disclosure

ED Bateman has served as a consultant to Actelion, Almirall, AstraZeneca, Boehringer Ingelheim; has been on advisory boards for Almirall, AstraZeneca, Boehringer Ingelheim, Forest, GlaxoSmithKline, Merck, Napp, Novartis and Takeda; has received lecture fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Pfizer and Takeda; and his institution has received remuneration for participation in clinical trials sponsored by Actelion, Aeras, Almirall, AstraZeneca, Boehringer Ingelheim, Forest, GlaxoSmithKline, Hoffman La Roche, Merck, Novartis and Takeda. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.