Randomized comparison of the efficacy and safety of ciclesonide and budesonide in adolescents with severe asthma

SummaryBackgroundThe aim of the study was to investigate the efficacy and safety of ciclesonide compared with budesonide in adolescents with severe asthma.MethodsIn this randomized, double-blind, double-dummy, parallel-group study, patients aged 12–17 years with severe asthma were treated with budesonide 400 μg once daily (QD) in a 2-week run-in period. At randomization, eligible patients were assigned 2:1 to ciclesonide 320 μg QD (ex-actuator) or budesonide 800 μg QD (metered dose), respectively, in the evening. Forced expiratory volume in 1 s (FEV1) was the primary variable. Patients recorded asthma symptom score and rescue medication use in diaries. Safety assessments included adverse events (AEs) and 24-h urine cortisol.ResultsFour hundred and three patients were randomized. Ciclesonide 320 μg QD and budesonide 800 μg QD significantly increased FEV1 (least-squares mean: 505 and 536 mL, respectively; both p<0.0001 versus baseline) in the intention-to-treat (ITT) population. Lower limits of the 95% confidence intervals (ITT: −138 mL; per-protocol: −122 mL) were above the non-inferiority limit (−150 mL). Median percentage of days without asthma symptoms and without rescue medication use was 84% with ciclesonide and 85% with budesonide. AEs were unremarkable, with no cases of confirmed candidiasis. Median creatinine-adjusted urine cortisol significantly decreased with budesonide treatment (15.9–13.7 nmol cortisol/mmol creatinine; p=0.0086 versus baseline), but not with ciclesonide (p=0.1125).ConclusionsCiclesonide 320 μg QD showed similar efficacy to budesonide 800 μg QD in adolescents with severe asthma. Ciclesonide was well tolerated and, unlike budesonide, had no effect on urine cortisol levels.Clinical trial registration numberEudraCT No.: 2004-001233-41.