Place in therapy review Ciclesonide in persistent asthma: the evidence of its therapeutic value Charlotte A. Kenreigh, Linda Timm Wagner, Paul Chrisp MLC Solutions Ltd, Galena, Ohio, USA, and Core Medical Publishing, Knutsford, UK Abstract Introduction: Asthma, a respiratory disease associated with airway inflammation and hyperresponsiveness, is one of the most prevalent chronic diseases worldwide affecting both children and adults. Inhaled corticosteroids are considered to be the cornerstone of asthma management. Ciclesonide, an airway-activated inhaled corticosteroid, has been developed for the management of persistent asthma. Its once-daily administration and airway activation may be advantageous in the treatment of asthma. Aims: The purpose of this article is to review the place in therapy of ciclesonide in the management of patients with persistent asthma based on the available clinical evidence. Evidence review: The available evidence indicates that ciclesonide has an effect on pulmonary function (forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow), as well as producing improvements in patient-reported symptoms that are equivalent to those achieved with other inhaled corticosteroids. A few studies have focused on health-related quality of life and have demonstrated a positive effect with ciclesonide treatment. Its pharmacokinetic profile may offer advantages in terms of adverse effects, both local and systemic, although most of the data come from 12-week studies. Place in therapy: The current evidence shows that ciclesonide offers another alternative among inhaled corticosteroids, with the potential for fewer adverse effects. The unique pharmacokinetic profile of ciclesonide allows once-daily administration and the airway activation of the drug appears to confer clinical benefit in the treatment of asthma. Its lack of systemic adverse effects make it a viable option for pediatric use. Key words: antiinflammatory, asthma, ciclesonide, evidence, inhaled corticosteroids, outcomes Core evidence place in therapy summary for ciclesonide in persistent asthma Evidence Implications Clear Clear Substantial Moderate Clear Clear Effects are similar to other inhaled corticosteroids Effects are similar to other inhaled corticosteroids Beneficial effects on patient-perceived quality of life Reduction in the regular use of oral corticosteroids likely to decrease the incidence of adverse systemic effects Lack of effect on hypothalamic–pituitary–adrenal axis for up to 1 year; suitable for use in pediatric patients Fewer local adverse effects (e.g. oropharyngeal effects) compared with other inhaled corticosteroids Ciclesonide as effective as budesonide and fluticasone, at least in the short term Outcome measure Patient-oriented evidence Improvement in asthma symptoms Reduction in rescue medication Improvement in quality of life Reduction in oral corticosteroid use Disease-oriented evidence Preservation of hypothalamic–pituitary–adrenal axis Substantial Lower incidence of local adverse effects Improvement in lung function (FEV1, FVC, PEF) Economic evidence Cost effectiveness as an inhaled corticosteroid in persistent asthma in adults and children FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; PEF, peak expiratory flow. No evidence Evidence required