Allergy Asthma Immunol Res.  2017 Mar;9(2):116-125. 10.4168/aair.2017.9.2.116.

Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids

• Postma DS
• Dekhuijzen R
• van der Molen T
• Martin RJ
• van Aalderen W
• Roche N
• Guilbert T
• Israel E
• van Eickels D
• Khalid JM
• Herings RM
• Overbeek J
• Miglio C
• Thomas V
• Hutton C
• Hillyer EV
• Price DB

• KMID: 2413385
• DOI: http://doi.org/10.4168/aair.2017.9.2.116

Abstract

PURPOSE
Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone).
METHODS
This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change.
RESULTS
Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide.
CONCLUSIONS
In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.

Keyword

Anti-asthmatic agents; comparative effectiveness research; disease exacerbation; small airway

MeSH Terms

Adrenal Cortex Hormones*
Anti-Asthmatic Agents
Asthma
Cohort Studies
Comparative Effectiveness Research
Diethylpropion
Disease Progression
Gastroesophageal Reflux
Hospitalization
Humans
Odds Ratio
Prevalence
Rhinitis
Adrenal Cortex Hormones
Anti-Asthmatic Agents
Diethylpropion

Figure

• 

  Fig. 1 Dose of inhaled corticosteroids prescribed at the initiation date. The doses of ciclesonide and fluticasone are reported as actual doses; the beclomethasone doses were halved and thus reported as fluticasone-equivalents, as per recommendations regarding corticosteroid equivalence.1236

• 

  Fig. 2 Adjusted rate ratios (RRs) and odds ratios (ORs) for ciclesonide relative to fine-particle ICS during the 1 outcome year for the co-primary endpoints (severe exacerbation RR, risk domain asthma control OR, and overall asthma control OR) and secondary endpoints (change in therapy OR and daily short-acting β2-agonist [SABA] use OR). *Adjusted for prescriptions of proton-pump inhibitors (yes/no) and baseline severe exacerbations (categorized); †Adjusted for age and prescriptions of proton-pump inhibitors (yes/no); ‡Adjusted for baseline overall asthma control and prescriptions of proton pump inhibitors (yes/no); §Adjusted for prescriptions of nasal corticosteroid preparations (yes/no); IIAdjusted for age and baseline SABA daily dose.

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