Efficacy and safety of inhaled corticosteroids relative to fluticasone propionate: a systematic review of randomized controlled trials in asthma
- 4 August 2017
- journal article
- review article
- Published by Taylor & Francis in Expert Review of Respiratory Medicine
- Vol. 11 (10), 763-778
- https://doi.org/10.1080/17476348.2017.1361824
Abstract
Introduction: Many trials have been published comparing inhaled corticosteroid (ICS) treatments in asthma. However, mixed results necessitate the summarization of available evidence to aid in decision-making. Areas covered: This systematic review evaluated randomized controlled trials (RCTs) that compared the efficacy and safety of inhaled fluticasone propionate (FP) with other ICS including beclomethasone dipropionate (BDP), budesonide (BUD) and ciclesonide (CIC). PubMed was searched and 54 RCTs that fit pre-determined criteria were included. Endpoints evaluated included lung function, asthma symptom control, exacerbation frequency, reliever use, quality of life and steroid-related side effects. Expert commentary: Across all studies, FP was associated with either more favorable or at least similar efficacy and safety, in comparison with BDP or BUD. This observation may be related to FP’s higher relative potency and almost negligible oral bioavailability. FP was comparable to CIC for efficacy. However, CIC appeared to have a smaller impact on cortisol levels than FP, which is likely due to CIC’s incomplete conversion to active metabolite (des-CIC) and the lower potency of des-CIC compared with FP. Although there were no significant differences in evaluated outcomes after treatment with different ICS in the majority of studies, some observed differences could be explained by their respective pharmacodynamic and pharmacokinetic properties.Keywords
Funding Information
- GlaxoSmithKline Pte Ltd (NA)
This publication has 82 references indexed in Scilit:
- The risk of asthma exacerbation after stopping low-dose inhaled corticosteroids: A systematic review and meta-analysis of randomized controlled trialsJournal of Allergy and Clinical Immunology, 2013
- Simultaneous determination of ciclesonide and its active metabolite desisobutyryl-ciclesonide in human plasma by LC–APCI-MS/MS: Application to pharmacokinetic study in healthy Chinese volunteersJournal of Pharmaceutical and Biomedical Analysis, 2011
- Factors and Mechanisms for Pharmacokinetic Differences between Pediatric Population and AdultsPharmaceutics, 2011
- Comparison of Effectiveness in Ciclesonide and Fluticasone Propionate on Small Airway Function in Mild AsthmaAllergology International, 2010
- A randomized, double-blind comparison of beclomethasone dipropionate extrafine aerosol and fluticasone propionateAnnals of Allergy, Asthma & Immunology, 2001
- Adrenocortical activity with repeated twice daily dosing of fluticasone propionate and budesonide given via a large volume spacer to asthmatic school childrenThorax, 1997
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Controlled Clinical Trials, 1996
- A comparison of fluticasone propionate 200 μg/day with beclomethasone dipropionate 400 μg/day in adult asthmaAllergy, 1994
- Comparison of the efficacy and safety of inhaled fluticasone propionate 200 micrograms/day with inhaled beclomethasone dipropionate 400 micrograms/day in mild and moderate asthma.Archives of Disease in Childhood, 1993
- Comparison of fluticasone propionate with beclomethasone dipropionate in moderate to severe asthma treated for one year. International Study Group.Thorax, 1993