Effectiveness of ciclesonide nasal spray in the treatment of seasonal allergic rhinitis

Background Ciclesonide is an investigational corticosteroid under development for treatment of allergic rhinitis. Ciclesonide is converted to active metabolite, desisobutyryl-ciclesonide (des-CIC), by upper and lower airway esterases. In vitro studies in human nasal epithelial cells and bronchial epithelial cells have demonstrated a long duration of anti-inflammatory activity of des-CIC. Objective To evaluate the dose-dependent efficacy and safety of a hypotonic intranasal formulation of ciclesonide in patients with seasonal allergic rhinitis (SAR). Methods This was a phase 2, randomized, parallel-group, double-blind, placebo-controlled study. Adults (n = approximately 145 per treatment group) with a minimum 2-year history of SAR received placebo or ciclesonide (25, 50, 100, or 200 μg/d) for 14 days. The primary end point was change in the sum of morning and evening reflective total nasal symptom scores (TNSSs) over 2 weeks. Safety was monitored throughout the study. Results Ciclesonide, 100 μg/d ( P = .04) and 200 μg/d ( P = .003), significantly improved the sum of morning and evening reflective TNSS vs placebo at more than 2 weeks of treatment. Baseline values for morning and evening reflective TNSS ranged from 17.80 to 18.82 across treatment groups. The average change from baseline in reflective TNSS was −4.2 for placebo and −4.8, −4.8, −5.3, and −5.8 for ciclesonide, 25, 50, 100, and 200 μg/d, respectively. There were no dose-related differences in the incidence of adverse events among treatment groups. Conclusions Results from this study indicate that 100-μg and 200-μg daily doses of ciclesonide are effective in the treatment of SAR. Ciclesonide, 200 μg/d, appears to be the optimal dose studied for reducing the symptoms of SAR while maintaining an acceptable safety profile.