Intranasal ciclesonide for allergic rhinitis

Williams, Ben; Smith, William B; Kette, Frank

doi:10.2147/jaa.s3082

Cited by 1 publication

(1 citation statement)

References 33 publications

(50 reference statements)

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“…Another study found that FF ANS (110 µg QD) had no effect on lower-leg growth rate in prepubertal children after two weeks of treatment, 48 while one-year treatment with FF ANS in prepubertal children did demonstrate a small reduction in growth without any other safety issue identified. 49 , 50 Growth velocity in children treated with nasal CIC has not been studied at the time of this review, 51 however, inhaled QD doses of CIC 40–160 µg were not found to significantly affect growth of children with asthma. 52 The impact of long-term treatment with INCS on adult height has not been studied, 41 but results of growth studies of ICS in children with asthma show little or no reduction in final adult height.…”

Section: Introductionmentioning

confidence: 96%

Intranasal Corticosteroids: Topical Potency, Systemic Activity and Therapeutic Index

Daley‐Yates¹,

Larenas‐Linnemann²,

Bhargave³

et al. 2021

JAA

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Intranasal corticosteroid (INCS) therapy is the preferred treatment option for allergic rhinitis (AR). Although all INCSs for the treatment of AR are considered safe and effective, differences in potency, molecular structure features and physicochemical and pharmacokinetic properties could result in differences in clinical efficacy and safety. Higher glucocorticoid receptor (GR) binding affinity of INCS is associated with higher lipophilicity, nasal tissue retention and topical potency. Higher topical potency is also accompanied by low oral bioavailability and high systemic clearance conferring low systemic exposure, reduced potential for systemic adverse effects and an improved therapeutic index. It has been shown that adverse events related to systemic exposure of INCSs in children are low. Although INCSs mostly produce low systemic effects, use of an INCS with low systemic exposure in patients on multiple corticosteroid (CS) therapies could help reduce the total systemic burden of CS therapy. Despite differences in topical potency, physicochemical and pharmacokinetic properties between INCSs, clinical studies of INCSs in the treatment of AR generally show no clinically important differences between these compounds, and poor correlation between INCS topical potency and clinical response. However, the lack of head-to-head comparisons of INCSs in clinical studies conducted in more severe AR patients should be noted. This narrative review provides an assessment of the therapeutic relevance of topical potency and the physicochemical and pharmacokinetic properties of INCSs and describes for the first time the relationship between topical potency and therapeutic index using pharmacological features of INCSs. It concludes that higher GR binding affinity and topical potency can potentially improve the therapeutic index of an INCS. Therefore, both efficacy and systemic exposure profiles should be considered when comparing INCS regimens in terms of therapeutic equivalence, to aid clinical decision-making and avoid the assumption that all INCS formulations are the same when considering treatment options.

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