The Effectiveness and Safety of Ciclesonide versus Fluticasone, Budesonide, and Beclomethasone in Treatment of Persistent Asthma: A Comprehensive Review of Literature

Ciclesonide is a lung-activated inhaled corticosteroid that provides effective control of persistent asthma. This study aimed to evaluate the safety and effectiveness of this drug compared to commonly used drugs including fluticasone, budesonide or beclomethasone.

The major medical electronic databases including Scopus, Web of Science, CINHAL, Cochrane Library and PubMed were searched in November 2012.

567 articles were found. After exclusion of duplicates and irrelevant articles, 11 randomized controlled trials (RCTs) and 5 systematic reviews were included. No significant difference was found between ciclesonide (CIC) with fluticasone propionate (FP), budesonide (BUD) and beclomethasone dipropionate (BDP) in lung function [forced expiratory volume in 1 second (FEV1) and am and pm peak expiratory flow (PEF)], asthma symptoms score, using rescue medicine and asthma exacerbation requiring use of systemic steroids. In addition, no significant difference was found in adverse events such as pharyngitis, rhinitis, upper respiratory infection, and withdrawal from the study due to adverse events or lack of efficacy. The quality of life score favored ciclesonide versus fluticasone. Candidiasis was less frequent with ciclesonide versus fluticasone. Change in the morning PEF between ciclesonide and beclomethasone dipropionate/budesonide was not clinically significant.

Ciclesonide and budesonide and beclomethasone gave similar results in safety and effectiveness. Ciclesonide improved the quality of life and reduced the oral candidacies compared to fluticasone. There was limited evidence when comparing ciclesonide with beclometasone.