A comparison of beclomethasone dipropionate and budesonide in the treatment of asthma.

Several reports have claimed that beclomethasone dipropionate (BDP) and budesonide (BUD) differ with regard to therapeutic efficacy and associated adverse effects, based either upon clinical data, or upon theoretical considerations. Although long-term comparisons are lacking, the consensus of numerous studies is that these drugs are of equivalent therapeutic efficacy. Assessment of pharmacological data suggests that beclomethasone 17-monopropionate (17-BMP), the active bronchial metabolite of BDP, has a greater glucocorticoid receptor affinity than BUD and thus theoretical claims for greater efficacy of BUD based on comparison with the receptor affinity of unchanged BDP are inaccurate. Similarly, clinical experience has not revealed any significant differences between the adverse effect profiles of BDP and BUD, in terms of adrenal suppression, changes in bone metabolism and growth, or cataract formation. Critical examination reveals that those reports describing differences in efficacy or safety profile between the two drugs have study design flaws which may undermine the validity of their conclusions. Current evidence indicates that, in terms of therapeutic efficacy and safety profile, BDP and BUD are effectively indistinguishable.