Ratner Paul, Darken Patrick, Wingertzahn Mark, Shah Tushar
Altana Pharma US, Florham Park, New Jersey, USA.
J Asthma. 2007 Oct;44(8):629-33. doi: 10.1080/02770900701554359.
Coexisting asthma and allergic rhinitis (AR) are often treated with both intranasal and inhaled corticosteroids. This study investigated whether intranasal ciclesonide 200 microg once daily has an additional effect on cortisol suppression when coadministered with inhaled hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP). Adult patients (n = 150) with perennial AR received HFA-BDP 320 microg twice daily and placebo once daily during a run-in period. Patients were then randomized to ciclesonide or placebo and HFA-BDP (43 days). A single 2-mg dose of dexamethasone was administered on the last treatment day. Plasma cortisol decreased by 67.8 microg x h/dL (p < 0.001) during the run-in period. When ciclesonide was added, the change in mean plasma cortisol was similar for ciclesonide and placebo (8.5 microg x h/dL and 1.0 microg x h/dL, respectively). Dexamethasone decreased mean plasma cortisol (p < 0.001), demonstrating that further cortisol suppression was possible. This study suggests that intranasal ciclesonide can be used with an inhaled corticosteroid without increased cortisol suppression.
哮喘与变应性鼻炎（AR）并存时，通常采用鼻内和吸入皮质类固醇联合治疗。本研究调查了每日一次鼻内给予200微克环索奈德与吸入丙酸倍氯米松氢氟烷烃（HFA-BDP）联用时，对皮质醇抑制是否有额外作用。成年常年性AR患者（n = 150）在导入期接受每日两次320微克HFA-BDP和每日一次安慰剂治疗。然后患者被随机分为环索奈德组或安慰剂组，并继续使用HFA-BDP治疗43天。在最后一个治疗日给予单次2毫克剂量地塞米松。导入期血浆皮质醇下降67.8微克·小时/分升（p < 0.001）。添加环索奈德后，环索奈德组和安慰剂组的平均血浆皮质醇变化相似（分别为8.5微克·小时/分升和1.0微克·小时/分升）。地塞米松降低了平均血浆皮质醇（p < 0.001），表明进一步抑制皮质醇是可能的。本研究提示，鼻内环索奈德与吸入皮质类固醇联合使用时，不会增加对皮质醇的抑制作用。
