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Ciclesonide

Classification: B

Drug products: Alvesco

ATC code: R03BA08

Substances: ciclesonide

Summary

Controlled studies on sex differences in efficacy and safety of ciclesonide are lacking. No clinically relevant pharmacokinetic sex differences have been reported.
 
In our opinion, the present evidence does not motivate differentiation in dosing or treatment between men and women.

Additional information

Some studies suggest that there are sex differences in expression and diagnosing of asthma, and it has been discussed if women are under-treated for respiratory diseases or not [5, 6].

Pharmacokinetics and dosing

The pharmacokinetics and pharmacodynamics of the active metabolite of ciclesonide (desisobutyryl-ciclesonide) was analyzed in a population study consisting of asthma patients (12 men, 20 women). Women had larger peripheral volume of distribution of desisobutyryl-ciclesonide. The maximum cortisol release rate was higher in women, but it’s unknown whether this is clinically relevant [7]. However, pooled from 12 phase I and three phase III studies in adults and two phase III studies in children (in total 300 males, 310 females) showed no clinically relevant sex differences in the pharmacokinetics of desisobutyryl-ciclesonide [8]. The manufacturer report no differences in pharmacokinetic of desisobutyryl-ciclesonide due to patient’s sex, age or race [9, 10].

Effects

No studies with a clinically relevant sex analysis of the effects of ciclesonide has been found.

Adverse effects

The manufacturer reports no sex differences in adverse effects from short-term trials in children and adults using ciclesonide nasal spray [9]. No studies on sex differences in adverse events in ciclesonide inhalation spray have been found.

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Other information

In a study on inhalation technique using metered dose inhalers (33 men, 26 women), 75% of the participants had an incorrect inhalation technique, especially women, regardless of age. Only 4% of women and 43% of men had an acceptable inhalation technique. The authors speculate that this may add to the worse asthma prognosis in women, shown in a meta-analysis of six trials of randomly assigned asthma treatment [1].

Several studies have shown worse prognosis for women with asthma. In an observational registry study (416 men, 498 women), women were found to have more asthmatic symptoms, worse quality of life and require more health care due to their asthma [2]. In a Danish prospective study on hospitalization due to asthma (6104 men of whom 2.5% had asthma, 7436 women of whom 2.2% had asthma), women had a 1.7 higher relative risk to be hospitalized [3]. An observational study from Singapore found hospitalization due to asthma to be more common in boys than girls aged 0-4 years (boys/girls ratio 1.69). In adults aged 35-64 years, women were more hospitalized (men/women ratio 0.81) [4].

Updated: 2019-02-26

Date of litterature search: 2017-06-21

References

  1. Goodman DE, Israel E, Rosenberg M, Johnston R, Weiss ST, Drazen JM. The influence of age, diagnosis, and gender on proper use of metered-dose inhalers. Am J Respir Crit Care Med. 1994;150:1256-61. PubMed
  2. Osborne ML, Vollmer WM, Linton KL, Buist AS. Characteristics of patients with asthma within a large HMO: a comparison by age and gender. Am J Respir Crit Care Med. 1998;157:123-8. PubMed
  3. Prescott E, Lange P, Vestbo J. Effect of gender on hospital admissions for asthma and prevalence of self-reported asthma: a prospective study based on a sample of the general population Copenhagen City Heart Study Group. Thorax. 1997;52:287-9. PubMed
  4. Ng TP, Niti M, Tan WC. Trends and ethnic differences in asthma hospitalization rates in Singapore, 1991 to 1998. Ann Allergy Asthma Immunol. 2003;90:51-5. PubMed
  5. Dales RE, Mehdizadeh A, Aaron SD, Vandemheen KL, Clinch J. Sex differences in the clinical presentation and management of airflow obstruction. Eur Respir J. 2006;28:319-22. PubMed
  6. Tantisira KG, Colvin R, Tonascia J, Strunk RC, Weiss ST, Fuhlbrigge AL et al. Airway responsiveness in mild to moderate childhood asthma: sex influences on the natural history. Am J Respir Crit Care Med. 2008;178:325-31. PubMed
  7. Xu J, Nave R, Lahu G, Derom E, Derendorf H. Population pharmacokinetics and pharmacodynamics of inhaled ciclesonide and fluticasone propionate in patients with persistent asthma. J Clin Pharmacol. 2010;50:1118-27. PubMed
  8. Rohatagi S, Krishnaswami S, Pfister M, Sahasranaman S. Model-based covariate pharmacokinetic analysis and lack of cortisol suppression by the new inhaled corticosteroid ciclesonide using a novel cortisol release model. Am J Ther. 2005;12:385-97. PubMed
  9. Omnaris (ciclesonide). DailyMed [www]. US National Library of Medicine. [updated 2017-12-05, cited 2017-12-20]. länk
  10. Alvesco (ciclesonide). DailyMed [www]. US National Library of Medicine. [updated 2015-11-17, cited 2017-06-21]. länk
  11. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2016 [cited 2017-06-20.] länk

Authors: Linnéa Karlsson Lind

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson