Department of Family and Community Medicine, University of Nevada School of Medicine, Reno, Nevada, USA.
Curr Opin Allergy Clin Immunol. 2011 Aug;11(4):337-44. doi: 10.1097/ACI.0b013e328348a813.
The purpose of this review is to compare and contrast the newer inhaled corticosteroid (ICS) ciclesonide with older ICSs in terms of pharmacodynamic and pharmacokinetic properties and how these affect comparative efficacy. In addition, clinical dosing strategies for ICSs including as-needed use will be explored.
Ciclesonide has demonstrated similar efficacy to that of fluticasone propionate and mometasone furoate in equipotent doses with a potentially improved therapeutic index. Once-daily administration of ICSs is generally not as effective as twice-daily. Continuous administration of ICSs does not change the natural history of asthma in either children or adults. Long-term administration of medium dose ICSs does not increase the risk of cataracts or osteopenia in children and young adults. Studies of as-needed ICSs in mild persistent asthma in adults and children have demonstrated mixed results, with some showing equal efficacy to continuous therapy and others showing superiority of continuous therapy.
Ciclesonide provides a newer ICS with favorable pharmacokinetics that may improve the therapeutic index, but assessment of its systemic effects such as growth await further studies. Continuous administration of ICSs in low to medium dose over many years is well tolerated. The use of as-needed ICSs in patients with mild persistent asthma is promising as a potential step-down therapy but awaits further studies.
本综述旨在比较新型吸入性皮质类固醇(ICS)环索奈德与旧 ICS 在药效学和药代动力学特性方面的差异,以及这些特性如何影响其相对疗效。此外,还将探讨 ICS 的临床给药策略,包括按需使用。
在等效剂量下,环索奈德与丙酸氟替卡松和糠酸莫米松具有相似的疗效,且可能具有更好的治疗指数。ICS 每日一次给药通常不如每日两次给药有效。ICS 的连续给药并不能改变儿童和成人哮喘的自然病程。长期给予中剂量 ICS 不会增加儿童和年轻成人白内障或骨质疏松症的风险。在成人和儿童轻度持续性哮喘中按需使用 ICS 的研究结果喜忧参半,一些研究表明与连续治疗等效,而另一些研究则表明连续治疗更优。
环索奈德提供了一种新型 ICS,具有良好的药代动力学特性,可能提高治疗指数,但对其全身作用(如生长)的评估仍有待进一步研究。低至中剂量的 ICS 连续多年给药耐受性良好。在轻度持续性哮喘患者中使用按需 ICS 作为潜在的降级治疗具有广阔前景,但仍需进一步研究。