Evidence map›Paper›PMID 25808113›Full record

ReviewBritish journal of clinical pharmacology2015

Inhaled corticosteroids: potency, dose equivalence and therapeutic index.

Peter T Daley-Yates

Registry-linked trialAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in British journal of clinical pharmacology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03803787 (Prophylactic Inhaled Steroids to Reduce Radiation Pneumonitis Frequency and Severity in Non-small Cell Lung Cancer Patients), which is not on this map. Cited by 105 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
105citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03803787 phase2recruitingnot on this mapstarted 2018, after this paper: background citation

Prophylactic Inhaled Steroids to Reduce Radiation Pneumonitis Frequency and Severity in Non-small Cell Lung Cancer Patients

TypeinterventionalSponsorInstituto Nacional de Cancerologia de MexicoRan2018 to 2027Enrolled72ConditionsRadiation PneumonitisArmsInhaled budesonide
3 · Its place in the literature

Who cites it

105 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Guideline
  4. Inhaled corticosteroids for the treatment of COVID-19.The Cochrane database of systematic reviews · 2022
    Pooled it
  5. Pooled it
  6. 2020 Brazilian Thoracic Association recommendations for the management of asthma.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia
    Guideline
  7. Trial
  8. Trial
  9. Trial
  10. Trial
  11. Trial
  12. Review
  13. Article
  14. Article
  15. Inhaled Corticosteroid/Long-Acting βAdvances in therapy · 2026
    Review
  16. Article
  17. Article
  18. Article
  19. Article
  20. Asthma and corticosteroids "Frontiers in allergy · 2026
    Review

45 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

1 author.

Peter T Daley-YatesClinical Pharmacology, GlaxoSmithKline, Research and Development, Uxbridge, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Glucocorticosteroids are a group of structurally related molecules that includes natural hormones and synthetic drugs with a wide range of anti-inflammatory potencies. For synthetic corticosteroid analogues it is commonly assumed that the therapeutic index cannot be improved by increasing their glucocorticoid receptor binding affinity. The validity of this assumption, particularly for inhaled corticosteroids, has not been fully explored. Inhaled corticosteroids exert their anti-inflammatory activity locally in the airways, and hence this can be dissociated from their potential to cause systemic adverse effects. The molecular structural features that increase glucocorticoid receptor binding affinity and selectivity drive topical anti-inflammatory activity. However, in addition, these structural modifications also result in physicochemical and pharmacokinetic changes that can enhance targeting to the airways and reduce systemic exposure. As a consequence, potency and therapeutic index can be correlated. However, this consideration is not reflected in asthma treatment guidelines that classify inhaled corticosteroid formulations as low-, mid- and high dose, and imbed a simple dose equivalence approach where potency is not considered to affect the therapeutic index. This article describes the relationship between potency and therapeutic index, and concludes that higher potency can potentially improve the therapeutic index. Therefore, both efficacy and safety should be considered when classifying inhaled corticosteroid regimens in terms of dose equivalence. The historical approach to dose equivalence in asthma treatment guidelines is not appropriate for the wider range of molecules, potencies and device/formulations now available. A more robust method is needed that incorporates pharmacological principles.

Indexed as

Administration, InhalationAnti-Inflammatory AgentsGlucocorticoidsHumansMolecular StructureProtein BindingReceptors, GlucocorticoidTherapeutic EquivalencyAnti-Inflammatory AgentsGlucocorticoidsReceptors, GlucocorticoidCorticosteroiddose equivalenceinhaledpotencytherapeutic index

Identifiers

PMID25808113
PMCPMC4574823

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.