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Comparison of Inhaled Corticosteroids: An Update
Objective: To review the basis for the estimated comparative daily dosages of inhaled corticosteroids for children and adults that are presented in the National Heart, Lung, and Blood Institute's Expert Panel Report 3; in addition, the pharmacodynamic and pharmacokinetic basis for potential cli...
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| Published in: | The Annals of pharmacotherapy 2009-03, Vol.43 (3), p.519-527 |
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| Format: | Article |
| Language: | English |
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| cites | cdi_FETCH-LOGICAL-c399t-17fc9984b3c4487b04b9ad254ec86a5d65ed6c84fb799394bb5ab4027511b71f3 |
| container_end_page | 527 |
| container_issue | 3 |
| container_start_page | 519 |
| container_title | The Annals of pharmacotherapy |
| container_volume | 43 |
| creator | Kelly, H William |
| description | Objective:
To review the basis for the estimated comparative daily dosages of inhaled corticosteroids for children and adults that are presented in the National Heart, Lung, and Blood Institute's Expert Panel Report 3; in addition, the pharmacodynamic and pharmacokinetic basis for potential clinical differences among inhaled corticosteroids is discussed.
Data Sources:
A complete MEDLINE search was conducted of human studies of asthma pharmacotherapy published between January 1, 2001, and March 15, 2006, followed by a PubMed search up until August 2008, using ciclesonide, inhaled corticosteroids, and pharmacokinetics as key words. Product information on each inhaled corticosteroid was also included.
Study Selection And Data Extraction:
Comparative clinical trials of inhaled corticosteroids and systematic reviews for efficacy comparisons were evaluated. Extensive literature reviews, meta-analyses, and selected clinical studies that illustrate or represent specific points of view were selected. Pharmacodynamic and pharmacokinetic data extracted from previously published reviews and specific studies were included.
Data Synthesis:
Pharmacodynamic characteristics (glucocorticoid receptor binding) and lung delivery determine the relative clinical efficacy and pharmacokinetic properties (oral bioavailability, lung retention, systemic clearance) and determine comparative therapeutic index of the inhaled corticosteroids. Secondary pharmacokinetic differences (intracellular fatty acid esterification, high serum protein binding) that have been posited to improve duration of action and/or therapeutic index are unproven, and current comparative clinical trials do not support the hypotheses that they provide an advantage. Ultrafine particle meter-dose inhalers (MDIs) have not demonstrated superior asthma control or improved safety over older MDIs. All of the inhaled corticosteroids demonstrate efficacy with once-daily dosing, and all are more effective when dosed twice daily.
Conclusions:
Current evidence suggests that all of the inhaled corticosteroids have sufficient therapeutic indexes to provide similar efficacy and safety in low to medium doses. Whether or not some of the newer inhaled corticosteroids offer any advantages at higher doses has yet to be determined. |
| doi_str_mv | 10.1345/aph.1L546 |
| format | article |
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To review the basis for the estimated comparative daily dosages of inhaled corticosteroids for children and adults that are presented in the National Heart, Lung, and Blood Institute's Expert Panel Report 3; in addition, the pharmacodynamic and pharmacokinetic basis for potential clinical differences among inhaled corticosteroids is discussed.
Data Sources:
A complete MEDLINE search was conducted of human studies of asthma pharmacotherapy published between January 1, 2001, and March 15, 2006, followed by a PubMed search up until August 2008, using ciclesonide, inhaled corticosteroids, and pharmacokinetics as key words. Product information on each inhaled corticosteroid was also included.
Study Selection And Data Extraction:
Comparative clinical trials of inhaled corticosteroids and systematic reviews for efficacy comparisons were evaluated. Extensive literature reviews, meta-analyses, and selected clinical studies that illustrate or represent specific points of view were selected. Pharmacodynamic and pharmacokinetic data extracted from previously published reviews and specific studies were included.
Data Synthesis:
Pharmacodynamic characteristics (glucocorticoid receptor binding) and lung delivery determine the relative clinical efficacy and pharmacokinetic properties (oral bioavailability, lung retention, systemic clearance) and determine comparative therapeutic index of the inhaled corticosteroids. Secondary pharmacokinetic differences (intracellular fatty acid esterification, high serum protein binding) that have been posited to improve duration of action and/or therapeutic index are unproven, and current comparative clinical trials do not support the hypotheses that they provide an advantage. Ultrafine particle meter-dose inhalers (MDIs) have not demonstrated superior asthma control or improved safety over older MDIs. All of the inhaled corticosteroids demonstrate efficacy with once-daily dosing, and all are more effective when dosed twice daily.
Conclusions:
Current evidence suggests that all of the inhaled corticosteroids have sufficient therapeutic indexes to provide similar efficacy and safety in low to medium doses. Whether or not some of the newer inhaled corticosteroids offer any advantages at higher doses has yet to be determined.</description><identifier>ISSN: 1060-0280</identifier><identifier>EISSN: 1542-6270</identifier><identifier>DOI: 10.1345/aph.1L546</identifier><identifier>PMID: 19261959</identifier><identifier>CODEN: APHRER</identifier><language>eng</language><publisher>Los Angeles, CA: Harvey Whitney Books</publisher><subject>Administration, Inhalation ; Adrenal Cortex Hormones - administration & dosage ; Adrenal Cortex Hormones - pharmacokinetics ; Adrenal Cortex Hormones - therapeutic use ; Adult ; Anti-Allergic Agents - pharmacokinetics ; Anti-Allergic Agents - therapeutic use ; Anti-Asthmatic Agents - administration & dosage ; Anti-Asthmatic Agents - pharmacokinetics ; Anti-Asthmatic Agents - therapeutic use ; Asthma - drug therapy ; Biological and medical sciences ; Child ; Chronic obstructive pulmonary disease, asthma ; Clinical Trials as Topic ; Drug Administration Schedule ; Drug Delivery Systems - instrumentation ; Drug Interactions ; Humans ; Medical sciences ; Nebulizers and Vaporizers ; Pharmacology. Drug treatments ; Pneumology ; Pregnenediones - pharmacokinetics ; Pregnenediones - therapeutic use ; Respiratory system ; Treatment Outcome</subject><ispartof>The Annals of pharmacotherapy, 2009-03, Vol.43 (3), p.519-527</ispartof><rights>2009 Harvey Whitney Books Company</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c399t-17fc9984b3c4487b04b9ad254ec86a5d65ed6c84fb799394bb5ab4027511b71f3</citedby><cites>FETCH-LOGICAL-c399t-17fc9984b3c4487b04b9ad254ec86a5d65ed6c84fb799394bb5ab4027511b71f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924,79135</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21261982$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19261959$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kelly, H William</creatorcontrib><title>Comparison of Inhaled Corticosteroids: An Update</title><title>The Annals of pharmacotherapy</title><addtitle>Ann Pharmacother</addtitle><description>Objective:
To review the basis for the estimated comparative daily dosages of inhaled corticosteroids for children and adults that are presented in the National Heart, Lung, and Blood Institute's Expert Panel Report 3; in addition, the pharmacodynamic and pharmacokinetic basis for potential clinical differences among inhaled corticosteroids is discussed.
Data Sources:
A complete MEDLINE search was conducted of human studies of asthma pharmacotherapy published between January 1, 2001, and March 15, 2006, followed by a PubMed search up until August 2008, using ciclesonide, inhaled corticosteroids, and pharmacokinetics as key words. Product information on each inhaled corticosteroid was also included.
Study Selection And Data Extraction:
Comparative clinical trials of inhaled corticosteroids and systematic reviews for efficacy comparisons were evaluated. Extensive literature reviews, meta-analyses, and selected clinical studies that illustrate or represent specific points of view were selected. Pharmacodynamic and pharmacokinetic data extracted from previously published reviews and specific studies were included.
Data Synthesis:
Pharmacodynamic characteristics (glucocorticoid receptor binding) and lung delivery determine the relative clinical efficacy and pharmacokinetic properties (oral bioavailability, lung retention, systemic clearance) and determine comparative therapeutic index of the inhaled corticosteroids. Secondary pharmacokinetic differences (intracellular fatty acid esterification, high serum protein binding) that have been posited to improve duration of action and/or therapeutic index are unproven, and current comparative clinical trials do not support the hypotheses that they provide an advantage. Ultrafine particle meter-dose inhalers (MDIs) have not demonstrated superior asthma control or improved safety over older MDIs. All of the inhaled corticosteroids demonstrate efficacy with once-daily dosing, and all are more effective when dosed twice daily.
Conclusions:
Current evidence suggests that all of the inhaled corticosteroids have sufficient therapeutic indexes to provide similar efficacy and safety in low to medium doses. Whether or not some of the newer inhaled corticosteroids offer any advantages at higher doses has yet to be determined.</description><subject>Administration, Inhalation</subject><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Adrenal Cortex Hormones - pharmacokinetics</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Adult</subject><subject>Anti-Allergic Agents - pharmacokinetics</subject><subject>Anti-Allergic Agents - therapeutic use</subject><subject>Anti-Asthmatic Agents - administration & dosage</subject><subject>Anti-Asthmatic Agents - pharmacokinetics</subject><subject>Anti-Asthmatic Agents - therapeutic use</subject><subject>Asthma - drug therapy</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Chronic obstructive pulmonary disease, asthma</subject><subject>Clinical Trials as Topic</subject><subject>Drug Administration Schedule</subject><subject>Drug Delivery Systems - instrumentation</subject><subject>Drug Interactions</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Nebulizers and Vaporizers</subject><subject>Pharmacology. Drug treatments</subject><subject>Pneumology</subject><subject>Pregnenediones - pharmacokinetics</subject><subject>Pregnenediones - therapeutic use</subject><subject>Respiratory system</subject><subject>Treatment Outcome</subject><issn>1060-0280</issn><issn>1542-6270</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNptz01LwzAYwPEgipvTg19AelHw0JnXtvE2ii-DgRd3Dkmarh1tU5KO4rc3c0Uvnp7n8ON5-ANwi-ASEcqeZF8t0YbR5AzMEaM4TnAKz8MOExhDnMEZuPJ-DyHkCPNLMEMcJ4gzPgcwt20vXe1tF9kyWneVbEwR5dYNtbZ-MM7WhX-OVl207Qs5mGtwUcrGm5tpLsD29eUzf483H2_rfLWJNeF8iFFaas4zqoimNEsVpIrLAjNqdJZIViTMFInOaKlSzgmnSjGpKMQpQ0ilqCQL8Hi6q5313plS9K5upfsSCIpjtQjV4qc62LuT7Q-qNcWfnDIDuJ-A9Fo2pZOdrv2vw-joMhzcw8l5uTNibw-uC43_fpwOVvWuGmtnhG9l04T_SIzjSIkggiFOvgFNF3eg</recordid><startdate>20090301</startdate><enddate>20090301</enddate><creator>Kelly, H William</creator><general>Harvey Whitney Books</general><general>SAGE Publications</general><general>Whitney</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20090301</creationdate><title>Comparison of Inhaled Corticosteroids: An Update</title><author>Kelly, H William</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c399t-17fc9984b3c4487b04b9ad254ec86a5d65ed6c84fb799394bb5ab4027511b71f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Administration, Inhalation</topic><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adrenal Cortex Hormones - pharmacokinetics</topic><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>Adult</topic><topic>Anti-Allergic Agents - pharmacokinetics</topic><topic>Anti-Allergic Agents - therapeutic use</topic><topic>Anti-Asthmatic Agents - administration & dosage</topic><topic>Anti-Asthmatic Agents - pharmacokinetics</topic><topic>Anti-Asthmatic Agents - therapeutic use</topic><topic>Asthma - drug therapy</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Chronic obstructive pulmonary disease, asthma</topic><topic>Clinical Trials as Topic</topic><topic>Drug Administration Schedule</topic><topic>Drug Delivery Systems - instrumentation</topic><topic>Drug Interactions</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Nebulizers and Vaporizers</topic><topic>Pharmacology. Drug treatments</topic><topic>Pneumology</topic><topic>Pregnenediones - pharmacokinetics</topic><topic>Pregnenediones - therapeutic use</topic><topic>Respiratory system</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kelly, H William</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>The Annals of pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kelly, H William</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Inhaled Corticosteroids: An Update</atitle><jtitle>The Annals of pharmacotherapy</jtitle><addtitle>Ann Pharmacother</addtitle><date>2009-03-01</date><risdate>2009</risdate><volume>43</volume><issue>3</issue><spage>519</spage><epage>527</epage><pages>519-527</pages><issn>1060-0280</issn><eissn>1542-6270</eissn><coden>APHRER</coden><abstract>Objective:
To review the basis for the estimated comparative daily dosages of inhaled corticosteroids for children and adults that are presented in the National Heart, Lung, and Blood Institute's Expert Panel Report 3; in addition, the pharmacodynamic and pharmacokinetic basis for potential clinical differences among inhaled corticosteroids is discussed.
Data Sources:
A complete MEDLINE search was conducted of human studies of asthma pharmacotherapy published between January 1, 2001, and March 15, 2006, followed by a PubMed search up until August 2008, using ciclesonide, inhaled corticosteroids, and pharmacokinetics as key words. Product information on each inhaled corticosteroid was also included.
Study Selection And Data Extraction:
Comparative clinical trials of inhaled corticosteroids and systematic reviews for efficacy comparisons were evaluated. Extensive literature reviews, meta-analyses, and selected clinical studies that illustrate or represent specific points of view were selected. Pharmacodynamic and pharmacokinetic data extracted from previously published reviews and specific studies were included.
Data Synthesis:
Pharmacodynamic characteristics (glucocorticoid receptor binding) and lung delivery determine the relative clinical efficacy and pharmacokinetic properties (oral bioavailability, lung retention, systemic clearance) and determine comparative therapeutic index of the inhaled corticosteroids. Secondary pharmacokinetic differences (intracellular fatty acid esterification, high serum protein binding) that have been posited to improve duration of action and/or therapeutic index are unproven, and current comparative clinical trials do not support the hypotheses that they provide an advantage. Ultrafine particle meter-dose inhalers (MDIs) have not demonstrated superior asthma control or improved safety over older MDIs. All of the inhaled corticosteroids demonstrate efficacy with once-daily dosing, and all are more effective when dosed twice daily.
Conclusions:
Current evidence suggests that all of the inhaled corticosteroids have sufficient therapeutic indexes to provide similar efficacy and safety in low to medium doses. Whether or not some of the newer inhaled corticosteroids offer any advantages at higher doses has yet to be determined.</abstract><cop>Los Angeles, CA</cop><pub>Harvey Whitney Books</pub><pmid>19261959</pmid><doi>10.1345/aph.1L546</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1060-0280 |
| ispartof | The Annals of pharmacotherapy, 2009-03, Vol.43 (3), p.519-527 |
| issn | 1060-0280 1542-6270 |
| language | eng |
| recordid | cdi_crossref_primary_10_1345_aph_1L546 |
| source | SAGE |
| subjects | Administration, Inhalation Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - pharmacokinetics Adrenal Cortex Hormones - therapeutic use Adult Anti-Allergic Agents - pharmacokinetics Anti-Allergic Agents - therapeutic use Anti-Asthmatic Agents - administration & dosage Anti-Asthmatic Agents - pharmacokinetics Anti-Asthmatic Agents - therapeutic use Asthma - drug therapy Biological and medical sciences Child Chronic obstructive pulmonary disease, asthma Clinical Trials as Topic Drug Administration Schedule Drug Delivery Systems - instrumentation Drug Interactions Humans Medical sciences Nebulizers and Vaporizers Pharmacology. Drug treatments Pneumology Pregnenediones - pharmacokinetics Pregnenediones - therapeutic use Respiratory system Treatment Outcome |
| title | Comparison of Inhaled Corticosteroids: An Update |
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