Efficacy and Safety of Ciclesonide Nasal Spray for the Treatment of Seasonal Allergic Rhinitis

University of Texas at San Antonio, San Antonio, Texas, United States
Journal of Allergy and Clinical Immunology (Impact Factor: 11.25). 12/2006; 118(5):1142-8. DOI: 10.1016/j.jaci.2006.07.050
Source: PubMed

ABSTRACT Allergic rhinitis (AR), an inflammatory disease of the nasal mucosa, affects approximately 25% of adults and 40% of children in the United States. Ciclesonide nasal spray is a corticosteroid being developed as a hypotonic formulation for AR.
We sought to evaluate the efficacy, safety, and tolerability of ciclesonide nasal spray in adult and adolescent patients with seasonal AR (SAR).
In this double-blind study patients (age, >or=12 years) were randomized to receive 200 microg of intranasal ciclesonide (n = 164) or placebo (n = 163) once daily for 28 days. The primary measure was morning and evening patient-assessed reflective total nasal symptom score (TNSS). Additionally, instantaneous TNSSs, physician-assessed overall nasal signs and symptoms severity, and the results of the Rhinoconjunctivitis Quality of Life Questionnaire were evaluated. Adverse events were monitored throughout the study.
Ciclesonide significantly improved average morning and evening reflective and instantaneous TNSSs compared with placebo over days 1 to 14 (P < .001). Improvements were also noted over days 1 to 28 (P < .001) and over days 15 to 28 (P = .011). Ciclesonide was well tolerated.
Intranasal ciclesonide was superior to placebo in relieving nasal symptoms in adult and adolescent patients with SAR. These results confirm the dose range-finding study in patients with SAR and support the efficacy of ciclesonide in AR.
In a clinical setting ciclesonide was shown to be safe and effective in the treatment of SAR in adolescent and adult patients.

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    • "This slow-release pool of active drug may contribute to the proven effi cacy of once-daily inhaled ciclesonide in asthma therapy, as was shown in several clinical studies (Postma et al 2001; Chapman et al 2004; Langdon et al 2005). The same holds true for once-daily intranasal ciclesonide in rhinitis therapy (Nave et al 2006b; Ratner et al 2006; Kim et al 2007). "
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    ABSTRACT: Ciclesonide is a novel corticosteroid (CS) for the treatment of asthma and allergic rhinitis. After administration, the parent compound ciclesonide is converted by intracellular airway esterases to its pharmacologically active metabolite desisobutyryl-ciclesonide (des-CIC). We investigated the in vitro activation of ciclesonide and further esterification of des-CIC to (mainly) des-CIC oleate in several human target organ test systems. Human precision-cut lung slices, alveolar type II epithelial cells (A549), normal bronchial epithelial cells (NHBE), and nasal epithelial cells (HNEC) were incubated with ciclesonide. Enzymes characterization and the determination of the reversibility of fatty acid esterification was investigated in HNEC and NHBE. Ciclesonide was taken up and converted to des-CIC in all cellular test systems. Intracellular concentrations of des-CIC were maintained for up to 24 h. Formation of des-CIC oleate increased over time in HNEC, A549 cells, and lung slices. The formed des-CIC fatty acid conjugates were reconverted to des-CIC. Increasing concentrations of carboxylesterase and cholinesterase inhibitors progressively reduced the formation of metabolites. The results derived from these studies demonstrate the activation of ciclesonide to des-CIC in the upper and lower airways. The reversible formation of des-CIC fatty acid conjugates may prolong the anti-inflammatory activity of des-CIC and may allow for once-daily dosing.
    Journal of Asthma and Allergy 09/2008; 1(1):11-8. DOI:10.2147/JAA.S4051
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    ABSTRACT: Artículo de revisión Revista Alergia México 2007;54(6):205-12 RESUMEN Numerosas enfermedades de las vías respiratorias superiores, como la rinitis alérgica, conjuntivitis alérgica y rinosinusitis, originan un proceso inflamatorio grave. En México la prevalencia de rinitis alérgica es de 25% en los adultos y 40% en los niños. El síntoma por el que acuden con mayor frecuencia a consulta es la congestión u obstrucción nasal, la cual afecta a más de 80% de los pa-cientes. Los corticoides intranasales tópicos constituyen el tratamiento de elección para la rinoconjuntivitis alérgica, principalmente moderada y grave. En comparación con los antihistamínicos y antileucotrienos, los corticosteroides intranasales son más efectivos para tratar la congestión u obstrucción nasal, asociada con trastornos del sueño y somnolencia matutina. El objetivo de este estudio fue revisar el mecanismo de acción de los corticosteroides intranasales, sus propiedades farmacológicas, prescripción, indicaciones y sugerencias para su aplicación adecuada. Palabras clave: corticosteroides, glucocorticoides, rinitis alérgica. ABSTRACT The different diseases that affect the upper respiratory tract, like allergic rhinitis, rhinoconjunctivitis, and rhinosinusitis have inflammation as their main pathophysiological component. Affects approximately 25% of the adults and 40% of the children. Intranasal corticoste-roids (INSs) are considered the most effective treatment for the management of allergic rhinoconjunctivitis. Unlike antihistamines or antileukotrienes , INSs have a more profound effect on nasal congestion and the related sleep disturbance and daytime somnolence resulting from nasal congestion that affect their everyday quality of life. We review INSs mechanism of action, pharmacological proper-ties of the different INSs, their therapeutic use and give our suggestions for their proper use.
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