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

Dirkje S Postma, Richard Dekhuijzen, Thys Van Der Molen, Richard J Martin, Wim van Aalderen, Nicolas Roche, Theresa W Guilbert, Elliot Israel, Daniela van Eickels, Javaria Mona Khlaid, Ron M C Herings, Jetty A Overbeek, Cristiana Miglio, Victoria Thomas, Catherine Hutton, Elizabeth V Hillyer, David B. Price

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PurposeExtrafine-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).MethodsThis 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.ResultsEach 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.ConclusionsIn 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.
Original languageEnglish
Article numbere45
Pages (from-to)116-125
Number of pages10
JournalAllergy, Asthma & Immunology Research
Issue number2
Early online date11 Oct 2016
Publication statusPublished - Mar 2017


  • anti-asthmatic agents
  • comparative effectiveness research
  • disease exacerbation
  • small airway

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    Postma, D. S., Dekhuijzen, R., Van Der Molen, T., Martin, R. J., van Aalderen, W., Roche, N., Guilbert, T. W., Israel, E., van Eickels, D., Khlaid, J. M., Herings, R. M. C., Overbeek, J. A., Miglio, C., Thomas, V., Hutton, C., Hillyer, E. V., & Price, D. B. (2017). Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids. Allergy, Asthma & Immunology Research, 9(2), 116-125. [e45].