Quantitative comparison of different inhaled corticosteroids in the
treatment of asthma in children aged 5-12
Abstract
Objective: Inhaled corticosteroids (ICS) are recommended by the Global
Initiative for Asthma for the treatment of steps 2-3 childhood asthma.
However, the difference in efficacy between these different ICS drugs is
not clear. The main purpose of this study was to compare the efficacy of
different ICS drugs in the treatment of childhood asthma and to provide
effective quantitative information for guiding their use. Methods: We
searched PubMed and EMBASE for randomized controlled trials of ICS in
the treatment of childhood asthma. Using forced expiratory volume in the
first second (FEV1) as the efficacy index, a time-course
model of ICS drugs was constructed. Related influencing factors were
also investigated. Important pharmacodynamic parameters, such as maximum
efficacy and onset time of each ICS, were calculated to reflect their
differences in efficacy characteristics. Results: A total of 6 studies
involving 2237 children were analyzed, including five arms of BUD (456
subjects), three arms of CIC (876 subjects), two arms of FP (352
subjects), one arm of MF (197 subjects), and three arms of FF (356
subjects). Since the study was limited by the data collected,
pharmacodynamic models could only be constructed for BUD and CIC. The
results showed that there was no significant difference in the maximum
efficacy between BUD and CIC, and that the Emax values
of the percentage change in FEV1 were 17.4 (95% CI:
16.9, 17.9)%. The ET50 of CIC and BUD was 1.23 (95%
CI: 0.76, 1.70) weeks and 2.97 (95% CI: 1.8, 4.14) weeks, respectively.
Compared with the 95% confidence intervals of BUD and CIC, FP had the
highest efficacy, MF had the lowest efficacy, and the efficacy of FF was
comparable to that of BUD and CIC. Conclusion: In this study, the
efficacy of five ICS drugs was quantitatively compared, providing
necessary information for the implementation of medication guidelines
for steps 2-3 asthma in children.