Intranasal ciclesonide coadministration with inhaled fluticasone propionate-salmeterol does not suppress cortisol in allergic rhinitis patients

Intranasal and inhaled corticosteroid administration concurrently in comorbid allergic rhinitis (AR) and asthma may potentially enhance cortisol suppression. This study determined whether intranasal ciclesonide 200 micro g once daily has an additional effect on cortisol suppression when coadministered with inhaled fluticasone propionate-salmeterol (FP-SAL) 500 to 50 micro g twice daily. Adults (N = 150) with perennial AR received FP-SAL and placebo nasal spray during the run-in period. Patients were randomized to ciclesonide or placebo and FP-SAL (43 days). A single 2-mg dose of dexamethasone was administered on the last treatment day. Plasma cortisol decreased during run-in period (p < 0.001), indicating cortisol suppression by FP-SAL. After ciclesonide was added to FP-SAL, plasma cortisol was similar in both groups. Dexamethasone decreased mean plasma cortisol (p < 0.001), demonstrating that further suppression was possible. Ciclesonide coadministered with FP-SAL did not have an additive effect on cortisol suppression compared with FP-SAL.