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Ciclesonide (Into the nose)

Treats symptoms of hay fever (allergic rhinitis). This medicine is a steroid.

What works?

Learn more about the effects of these drugs. The most reliable research is summed up for you in our featured article.

Ciclesonide nasal spray is used to treat an itchy or runny nose, sneezing, or other symptoms caused by perennial (year-round) or seasonal hay fever (allergic rhinitis). It is a steroid (cortisone-like medicine) that works by preventing the inflammation that occurs with allergic reactions. This medicine is available only with your doctor's prescription… Read more
Brand names include
Omnaris, Zetonna
Other forms
By breathing
Drug classes About this
Anti-Inflammatory, Endocrine-Metabolic Agent

What works? Research summarized

Evidence reviews

Ciclesonide versus placebo for chronic asthma in adults and children

In asthma, inflammation (swelling in the wall) narrows the airway and is the main factor giving rise to asthmatic symptoms of cough, wheeze, shortness of breath and chest tightness. Inhaled corticosteroids (ICS) which are given usually more than once daily are now recommended as first line therapy for most people with asthma. The currently available ICS, such as budesonide (BUD), beclomethasone (BDP) or fluticasone (FP), have been available for many years and have proven to be an important therapy for controlling inflammation and symptoms. However, these drugs can be associated with significant side‐effects, especially local effects in the upper airways such as hoarseness and oral candida (thrush infection). The main reputed advantage of ciclesonide (CIC, a new generation of ICS), is its ability not only (as with other ICS) to be delivered locally by inhalation but specifically to the lower airways of the lung in a form which potentially minimises local side‐effects. Overall this advantage of CIC could lead to a reduction of local airway side‐effects with once daily therapy and thereby improving adherence to therapy. The results from this review indicate that CIC at low to moderate doses improves lung function and reduces asthma symptoms compared to placebo, but the short duration of the studies means that there is a lack of information about the impact on asthma exacerbations. Thus the currently recommended doses of CIC of 100‐200 mcg daily would seem appropriate. However, the number of studies in the higher dose range are low and further studies are therefore required in adults and children to determine whether higher CIC doses will give significant benefit without increasing adverse events. It will also be important to determine in clinical studies how CIC compares to the other currently available ICS in terms of efficacy and safety in asthmatic adults and children in order to determine the precise role of CIC therapy in asthma. The published data are insufficient to assess the reputed safety advantage of ciclesonide, and better assessment and reporting in studies is required to address this important question.

Ciclesonide versus other inhaled steroids for chronic asthma in children and adults

Inhaled corticosteroids, such as budesonide, beclomethasone or fluticasone, which have been available for many years, have proven to be an important therapy for controlling the inflammation caused by asthma. They are given usually twice daily, and are recommended therapy in international guidelines for most asthmatics. However, the currently available inhaled corticosteroids can be associated with significant side‐effects, including local effects in the upper airways such as hoarseness and oral candida (thrush infection). Ciclesonide is a new steroid which is reported to make less of the active steroid available until the drug reaches the lung on inhalation, which could reduce the likelihood of throat symptoms. This findings of this review of 21 trials (7243 participants) do not allow certainty about the relative efficacy of ciclesonide compared to older inhaled corticosteroids, especially at higher doses. The results of the review to date do not indicate whether ciclesonide provides a significantly more useful safety profile that other inhaled corticosteroids at similar equivalent doses. However, the finding of lower oral candidiasis in patients treated with ciclesonide compared to fluticasone may be important for those patients who experience oral thrush with their current ICS. In addition, further studies in children are required to obtain data on the side‐effect profile of ciclesonide in this population.

Ciclesonide compared to budesonide and fluticasone in the treatment of asthma in children

Asthma is a common disease in childhood. Most children with chronic asthma are treated with inhaled corticosteroids (ICS) to control airway inflammation and reduce asthma symptoms. Although these drugs are considered to be very safe and effective, not all children achieve full asthma control and some parents are concerned about the possibility of reduced growth or local side effects such as hoarseness. The challenge for newer ICS is to achieve improved asthma control with fewer side effects. This could be achieved by small‐particle‐size ICS, leading to better lung deposition as they penetrate deeper into the small airways. Therefore, asthma control could be achieved with lower daily doses and with fewer side effects. In children, particle size of ICS might be even more important because of their smaller airways.

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Summaries for consumers

Ciclesonide versus placebo for chronic asthma in adults and children

In asthma, inflammation (swelling in the wall) narrows the airway and is the main factor giving rise to asthmatic symptoms of cough, wheeze, shortness of breath and chest tightness. Inhaled corticosteroids (ICS) which are given usually more than once daily are now recommended as first line therapy for most people with asthma. The currently available ICS, such as budesonide (BUD), beclomethasone (BDP) or fluticasone (FP), have been available for many years and have proven to be an important therapy for controlling inflammation and symptoms. However, these drugs can be associated with significant side‐effects, especially local effects in the upper airways such as hoarseness and oral candida (thrush infection). The main reputed advantage of ciclesonide (CIC, a new generation of ICS), is its ability not only (as with other ICS) to be delivered locally by inhalation but specifically to the lower airways of the lung in a form which potentially minimises local side‐effects. Overall this advantage of CIC could lead to a reduction of local airway side‐effects with once daily therapy and thereby improving adherence to therapy. The results from this review indicate that CIC at low to moderate doses improves lung function and reduces asthma symptoms compared to placebo, but the short duration of the studies means that there is a lack of information about the impact on asthma exacerbations. Thus the currently recommended doses of CIC of 100‐200 mcg daily would seem appropriate. However, the number of studies in the higher dose range are low and further studies are therefore required in adults and children to determine whether higher CIC doses will give significant benefit without increasing adverse events. It will also be important to determine in clinical studies how CIC compares to the other currently available ICS in terms of efficacy and safety in asthmatic adults and children in order to determine the precise role of CIC therapy in asthma. The published data are insufficient to assess the reputed safety advantage of ciclesonide, and better assessment and reporting in studies is required to address this important question.

Ciclesonide versus other inhaled steroids for chronic asthma in children and adults

Inhaled corticosteroids, such as budesonide, beclomethasone or fluticasone, which have been available for many years, have proven to be an important therapy for controlling the inflammation caused by asthma. They are given usually twice daily, and are recommended therapy in international guidelines for most asthmatics. However, the currently available inhaled corticosteroids can be associated with significant side‐effects, including local effects in the upper airways such as hoarseness and oral candida (thrush infection). Ciclesonide is a new steroid which is reported to make less of the active steroid available until the drug reaches the lung on inhalation, which could reduce the likelihood of throat symptoms. This findings of this review of 21 trials (7243 participants) do not allow certainty about the relative efficacy of ciclesonide compared to older inhaled corticosteroids, especially at higher doses. The results of the review to date do not indicate whether ciclesonide provides a significantly more useful safety profile that other inhaled corticosteroids at similar equivalent doses. However, the finding of lower oral candidiasis in patients treated with ciclesonide compared to fluticasone may be important for those patients who experience oral thrush with their current ICS. In addition, further studies in children are required to obtain data on the side‐effect profile of ciclesonide in this population.

Ciclesonide compared to budesonide and fluticasone in the treatment of asthma in children

Asthma is a common disease in childhood. Most children with chronic asthma are treated with inhaled corticosteroids (ICS) to control airway inflammation and reduce asthma symptoms. Although these drugs are considered to be very safe and effective, not all children achieve full asthma control and some parents are concerned about the possibility of reduced growth or local side effects such as hoarseness. The challenge for newer ICS is to achieve improved asthma control with fewer side effects. This could be achieved by small‐particle‐size ICS, leading to better lung deposition as they penetrate deeper into the small airways. Therefore, asthma control could be achieved with lower daily doses and with fewer side effects. In children, particle size of ICS might be even more important because of their smaller airways.

See all (9)

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