Local and systemic adverse effects of inhaled corticosteroids - Does ciclesonide differ from other inhaled corticosteroids?

Background and aim
The pharmacological profile of ciclesonide suggests that it may be associated with fewer local and systemic adverse effects compared to other inhaled corticosteroids. The aim of this systematic review is to provide an update on the current evidence of the local and systemic adverse effects of ciclesonide for the treatment of asthma compared to other inhaled corticosteroids.
Methods
Systematic review performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guidelines. The search was last updated in September 2024. The search algorithm consisted of the following Medical Subject Headings (MeSH) terms: (ciclesonide) AND (asthma).
Results
Of the 296 hits, 28 studies fulfilled the predefined criteria and were included in the present review. A total of 15 out of 25 studies addressing local adverse effects showed insignificant differences between ciclesonide and the comparative inhaled corticosteroid. Of these 15 studies, 13 were randomized controlled trials (RCTs). Seven RCTs reported a reduced risk of local adverse effects associated with ciclesonide-treatment. One observational study found ciclesonide treated patients more likely to have been treated for oropharyngeal candidiasis compared to patients treated with another inhaled corticosteroid.
Twelve studies investigated systemic adverse effects of CIC vs. other inhaled corticosteroid. Of the nine trials measuring urine cortisol suppression compared to baseline, seven found no suppression in the ciclesonide treated groups in contrast to a significant suppression in the comparative inhaled corticosteroid treated groups. On the contrary, two trials found no suppression in either treatment group. Two of three studies assessing HPA-axis function by plasma cortisol response to corticotropin-releasing factor reported no difference between ciclesonide and fluticasone propionate, whereas one found significantly reduced response with fluticasone treatment, but not with ciclesonide. One study assessed the risk of developing signs of cataract and found no significant difference between ciclesonide and other inhaled corticosteroids, and another investigated patient reported adverse effects and found superiority in CIC to FP in terms of reducing “vision deterioration”.
Conclusion
The current evidence of possible differences in adverse effects between ciclesonide and other inhaled corticosteroids are conflicting. However, there is some evidence in favor of fewer local adverse effects in ciclesonide treated patients and, additionally, ciclesonide treatment is either more favorable or similar to other inhaled corticosteroids with regard to systemic adverse effects.