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Comparison of inhaled corticosteroids

H W Kelly1

  • 1College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque 87131, USA. hwkelly@unm.edu

The Annals of Pharmacotherapy
|March 13, 1998
PubMed
Summary

Inhaled corticosteroids (ICS) show varying potencies for asthma management. While in vitro measures predict antiasthmatic potency, current evidence suggests similar safety profiles when used at equipotent anti-inflammatory doses.

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Area of Science:

  • Pulmonology
  • Pharmacology
  • Clinical Medicine

Background:

  • Inhaled corticosteroids (ICS) are cornerstone therapy for persistent asthma.
  • Understanding the relative potencies and safety profiles of different ICS is crucial for optimizing treatment.

Purpose of the Study:

  • To review comparative studies on the efficacy and safety of inhaled corticosteroids in asthma management.
  • To determine the relative potencies of various inhaled corticosteroids based on clinical trials.

Main Methods:

  • A critical review of published clinical trials comparing efficacy or systemic activity of ICS.
  • Evaluation of studies using surrogate measures for antiasthmatic activity.

Main Results:

  • In vitro anti-inflammatory activity correlates with clinical antiasthmatic potency.
  • Rank order of potency: flunisolide = triamcinolone acetonide < beclomethasone dipropionate = budesonide < fluticasone.
  • No evidence of superior efficacy at equipotent doses; similar systemic risk profiles observed.

Conclusions:

  • Delivery systems significantly impact ICS topical and systemic activity.
  • Further comparative studies are needed to establish topical-to-systemic activity ratios.
  • ICS are not equipotent on a microgram basis.

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