Alvesco (ciclesonide) - review of marketing brochure

Alvesco (ciclesonide) brochure uses green branding but the Alvesco MDI devices are brown (80 mcg) and red (160 mcg), respectively. There is risk for brand and patient confusion here.

Alvesco 80 mcg inhaler in brown and Alvesco 160 mcg inhaler in red. The marketing brochure itself however "promotes" the green brand color. For comparison, Symbicort inhalers are red and Advair Diskus devices are purple.

More information is available at:

Ciclesonide particles are exactly the same size as the beclomethasone particles (1.1 micrometers) but the clever use of perspective in the brochure makes them look smaller. The clinical significance of the particle size is unknown however. For example, the size of fluticasone particles (2.4 micrometer) is twice the size of beclomethasone particles (1.1 micrometers), which in theory should result in better lung deposition. Yet, fluticasone is twice as effective as beclomethasone. Budesonide has the largest particles in this graph at 5 micrometers - 4 times the size of a ciclesonide particles.

Switching the discussion to LABAs, formoterol has an advantage over salmeterol in terms of quicker action. One can make the case that the ideal ICS/LABA combination would be ciclesonide and formoterol (compared to Advair or Symbicort) because of:- smaller particle size (ciclesonide)- local activation (ciclesonide)- faster onset of action (salmeterol)Classically, dry powder inhalers (DPIs) have been the devices with the best lung deposition. However, if you look at the diagram above, the HFA solution achieve even greater deposition - 60% for HFA solutions vs. 28% for DPIs.

The diagram reflects differences in the area under the curve when evaluating the effect of ciclesonide and placebo on the adrenal function. Yet, the lower ciclesonide dose seems to be "better" than placebo while the higher dose is "worse." The absolute difference are small and this type of diagrams can be confusing.

Ciclesonide mnemonic

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

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