Postma, Dirkje S.Dekhuijzen, Richardvan der Molen, ThysMartin, Richard J.van Aalderen, WimRoche, NicolasGuilbert, Theresa W.Israel, Elliotvan Eickels, DanielaKhalid, Javaria MonaHerings, Ron M.C.Overbeek, Jetty A.Miglio, CristianaThomas, VictoriaHutton, CatherineHillyer, Elizabeth V.Price, David B.2017-04-062017Postma, D. S., R. Dekhuijzen, T. van der Molen, R. J. Martin, W. van Aalderen, N. Roche, T. W. Guilbert, et al. 2017. “Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids.” Allergy, Asthma & Immunology Research 9 (2): 116-125. doi:10.4168/aair.2017.9.2.116. http://dx.doi.org/10.4168/aair.2017.9.2.116.http://nrs.harvard.edu/urn-3:HUL.InstRepos:32071967Purpose Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone). Methods: This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change. Results: Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide. Conclusions: In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.en-USAnti-asthmatic agentscomparative effectiveness researchdisease exacerbationsmall airwayJournal Article2017-04-0610.4168/aair.2017.9.2.116