Onset of action of ciclesonide in the treatment of seasonal allergic rhinitis: 6 hours

Ciclesonide is an intranasal corticosteroid (INS) approved for the treatment of allergic rhinitis (AR) in adults and children 6 years of age and older. The trade name in the U.S. is Omnaris.

Ciclesonide seems to have no significant effect on hypothalamic-pituitary-adrenal axis.

Why ciclesonide has no significant effect on hypothalamic-pituitary-adrenal axis?

The medication is "activated" locally in the lungs. Carboxylesterases in bronchial epithelial cells convert ciclesonide to des-CIC in the lungs. Low systemic levels of des-CIC are a result of the high metabolic clearance by the liver following CIC inhalation.

In a double-blind, randomized, placebo-controlled study, 509 adults with at least a 2-year history of SAR completed 1 to 5 priming sessions of ragweed pollen exposure. Patients with successful priming visits received a single dose of intranasal ciclesonide, 200 microg or placebo.

The change from baseline in TNSSs between the ciclesonide and placebo groups was measured hourly 1 to 12 hours.

The authors concluded that intranasal ciclesonide, 200 microg/d, has an onset of action of 6 hours in patients with SAR.

Ciclesonide is marketed under the brand name Alvesco for asthma and Omnaris/Omniair for hayfever in the US and Canada.



Treatment Options for Allergic Rhinitis (click to enlarge the image).

Ciclesonide mnemonic

C
Ciclesonide
Converted to active form (des-CIC)
Carboxyl-esterases in bronchial epithelial cells
Clearance by liver

References:

Onset of action of ciclesonide once daily in the treatment of seasonal allergic rhinitis. Couroux P, Kunjibettu S, Hall N, Wingertzahn MA. Ann Allergy Asthma Immunol. 2009 Jan;102(1):62-8.

New Dry Nasal Spray are on the Horizon for Perennial Allergic Rhinitis - Medscape, 2011.

Ciclesonide Aerosol (Alvesco) Approved for Asthma Treatment

Mind Maps: Allergic Rhinitis

Images source: Wikipedia, a free GNU license and public domain.

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