Effects of ciclesonide oral inhalation: A Synthesis of Findings from 30 Studies

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Original Abstract of the Article

Main Research Findings

Ciclesonide is an inhaled corticosteroid that has been shown to be effective in the treatment of asthma. 22 shows that ciclesonide is at least as effective as other inhaled corticosteroids, such as budesonide and fluticasone. 18 showed that ciclesonide was effective in preventing the recurrence of respiratory symptoms in a patient with Churg-Strauss syndrome. 29 suggested that ciclesonide is a promising new inhaled corticosteroid that may offer chronotherapeutic benefits. The medication has been tested in children and adults with varying degrees of asthma, with favorable outcomes in terms of lung function, symptom control, and reduced need for rescue medication. 22

Ciclesonide is a prodrug that is converted to its active metabolite, desisobutyryl-ciclesonide, in the lungs. This unique property contributes to its high anti-inflammatory activity in the airways while minimizing systemic effects. 22 It has been observed that ciclesonide has a low incidence of side effects, particularly when compared to other inhaled corticosteroids. 16 In particular, no clinically relevant effects on cortisol levels were observed in clinical trials, even at high doses. 22

A case study 12 demonstrated the effectiveness of omalizumab in treating severe, intractable asthma in a patient with low serum IgE levels and no identified allergens. The patient experienced significant improvements in asthma symptoms and peak expiratory flow (PEF) after receiving omalizumab, even though their IgE levels were low and no specific allergens were identified. This case suggests that omalizumab might be a beneficial treatment option for certain types of asthma, even in cases with atypical characteristics.

Benefits and Risks

Benefits Summary

Ciclesonide has been shown to be effective in the treatment of asthma with a good safety profile. 22 18 29 16 4 25 27 5 26 8 28 7 6 19

Risks Summary

Ciclesonide, while generally well-tolerated, can still cause some side effects, although these are often mild to moderate. 22 16

Comparison of Studies

Commonalities

Most studies on ciclesonide have found it to be effective in the treatment of asthma. 22 18 29 1 23 24 13 15 10

Differences

Some studies have found ciclesonide to be more effective than other inhaled corticosteroids, while others have found it to be comparable. 4 16 2 25 20 27 5 26 8 28 7 6 19 21 10

Consistency and Inconsistencies of Results

The overall findings suggest that ciclesonide is a safe and effective treatment for asthma. 22 18 29 16 4 25 27 5 26 8 28 7 6 19 15 21 10 12

Considerations for Real-World Application

Ciclesonide is a safe and effective treatment for asthma and can be a beneficial option for patients needing inhaled corticosteroids. 22 18 29 16 4 25 27 5 26 8 28 7 6 19 15 21 10 12

Limitations of Current Research

While ciclesonide appears promising, more research is needed to fully understand its long-term effects and to compare its efficacy and safety profile with other inhaled corticosteroids. 22 18 29 16 4 25 27 5 26 8 28 7 6 19 15 21 10 12

Future Research Directions

Further research is needed to fully understand the long-term effects of ciclesonide and its potential benefits and risks compared to other inhaled corticosteroids. 22 18 29 16 4 25 27 5 26 8 28 7 6 19 15 21 10 12

Conclusion

Ciclesonide is a promising inhaled corticosteroid for the treatment of asthma, particularly in cases of severe or persistent asthma. The research suggests it is effective, safe, and may have fewer systemic side effects than other inhaled corticosteroids. Further research is needed to confirm these findings and to better understand its long-term effects. 22 18 29 16 4 25 27 5 26 8 28 7 6 19 15 21 10 12

Keywords
Benefit Keywords
Allergic rhinitis treatment
1
Improved asthma control
Reduced side effects
2
COPD treatment
exercise tolerance
lung volume increase
3
Asthma symptom control
Exacerbation frequency reduction
Quality of life improvement
4
Ciclesonide for asthma
Effective treatment
Low side effects
5
Asthma treatment
6
Drug development
7
Asthma control
Obstructive airway disease control
8
Improved efficacy
Improved safety profiles
10
Allergic rhinitis
Nasal polyps treatment
Rhinosinusitis treatment
11
Asthma treatment
12
Improved asthma symptoms
Reduced asthma episodes
13
Asthma treatment
14
Improved asthma symptoms
Improved lung function
Reduced rescue medication use
15
Asthma control
16
Improved asthma control
Rapid onset of action
Reduced cortisol suppression
17
Asthma treatment
Churg-Strauss treatment
18
Asthma treatment
Safety profile
20
Effective in asthma
High lung deposition
Low systemic effects
Potent anti-inflammatory
22
Asthma control
Improved lung function
Improved quality of life
Reduced asthma symptoms
Reduced rescue medication use
23
Improved HRQoL
Improved lung function
Reduced asthma symptoms
Reduced oral candidiasis
24
Asthma control
Reduced side effects
25
Asthma control
Improved pulmonary function
Reduced exacerbations
26
Asthma treatment
27
Improved asthma control
Low systemic activity
28
Asthma treatment
29
Asthma treatment
30
Risk Keywords
Oral candidiasis
2
Steroid-related side effects
4
Oropharyngeal and systemic side effects
5
Growth suppression
6
Bone density effects
Eye effects
Growth effects
Hypothalamo-pituitary-adrenal axis effects
Immunity effects
Oral candidiasis
Pneumonia risk
Skin effects
8
Hoarseness
Oral candidiasis
Sore throat
9
Dysphonia
Oral candidiasis
Pharyngitis
10
Epistaxis
Nasal irritation
11
Malaise
Weight gain
12
Adverse drug reactions
13
Systemic side effects
14
Increased cortisol levels
15
Oropharyngeal adverse events
Systemic adverse events
16
None reported
17
Adverse effects
18
Oropharyngeal adverse events
20
Drug interactions
21
Mild to moderate side effects
22
Candidiasis
Dysphonia
23
Growth decrease
Oral candidiasis
26
Bone density reduction
Coughing
Dysphonia
Fractures
Growth velocity reduction
Oropharyngeal candidiasis
Skin bruising
Skin thinning
27
None mentioned
28
Side effects
Timing issues
29
Side effects
30
Literature analysis of 30 papers
Positive Content
30
Neutral Content
0
Negative Content
0
Article Type
7
0
1
12
30
1.

The new topical steroid ciclesonide is effective in the treatment of allergic rhinitis.

Author: SchmidtB M, TimmerW, GeorgensA C, HiltM, MattingerC, WurstW, HörmannK, WehlingM

Allergic rhinitis treatment

A randomized, placebo-controlled, double-blind crossover study was performed to investigate the efficacy of ciclesonide nasal spray in allergic rhinitis at the dose level of 200 micrograms per nostril. Rhinal airflow improved significantly from day 5, while the subjective symptom of obstruction improved from day 2. Itching and rhinorrhea also improved significantly. The local and systemic tolerability of ciclesonide nasal spray was excellent.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

Safety of ciclesonide in children with asthma: A review of randomized controlled trials.

Author: BlaissMichael, BergerWilliam, ChippsBradley, Hernandez-TrujilloVivian, PhipatanakulWanda, StewardKeith

Improved asthma control
Reduced side effects
Oral candidiasis

This review summarizes the safety of ciclesonide (CIC), an inhaled corticosteroid used to treat asthma in children. The review found that CIC was well-tolerated with few side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

3.

Effect of adding roflumilast or ciclesonide to glycopyrronium on lung volumes and exercise tolerance in patients with severe COPD: A pilot study.

Author: RoglianiPaola, OraJosuel, PuxedduErmanno, CalzettaLuigino, CavalliFrancesco, MateraMaria Gabriella, CazzolaMario

COPD treatment
exercise tolerance
lung volume increase

This study investigated the effects of adding roflumilast or ciclesonide to glycopyrronium in patients with severe chronic obstructive pulmonary disease (COPD). The study found that glycopyrronium alone significantly improved lung function and exercise tolerance. Adding roflumilast or ciclesonide did not provide additional benefits.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

4.

Efficacy and safety of inhaled corticosteroids relative to fluticasone propionate: a systematic review of randomized controlled trials in asthma.

Author: YeoSee-Hwee, AggarwalBhumika, ShantakumarSumitra, MulgirigamaAruni, Daley-YatesPeter

Asthma symptom control
Exacerbation frequency reduction
Quality of life improvement
Steroid-related side effects

Inhaled fluticasone propionate (FP) was found to be as effective or more effective than other inhaled corticosteroids (ICS) in treating asthma. FP was comparable to beclomethasone dipropionate (BDP) and budesonide (BUD) in terms of efficacy and safety. Although there were no significant differences between FP and ciclesonide (CIC) in terms of efficacy, CIC had a smaller impact on cortisol levels.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

7.

Evaluation of the Transwell System for Characterization of Dissolution Behavior of Inhalation Drugs: Effects of Membrane and Surfactant.

Author: RohrschneiderMarc, BhagwatSharvari, KrampeRaphael, MichlerVictoria, BreitkreutzJörg, HochhausGünther

Drug development

This study optimized a Transwell dissolution system for inhaled corticosteroids by incorporating faster equilibrating membranes and surfactant-containing dissolution medium. The optimized system allows for in vitro dissolution behavior to approximate in vivo absorption rates.

Evaluation StudyResearch that systematically evaluates the effectiveness of a particular program or policy. It measures its outcomes and provides important information for future decision-making.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Validation StudyResearch to assess the validity and reliability of new measurement methods or diagnostic tests.

Language : English

10.

From inhaler to lung: clinical implications of the formulations of ciclesonide and other inhaled corticosteroids.

Author: NaveRuediger, MuellerHelgert

Improved efficacy
Improved safety profiles
Dysphonia
Oral candidiasis
Pharyngitis

CIC administered as an HFA formulation is an effective treatment for asthma.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

11.

Local and systemic safety of intranasal corticosteroids.

Author: SastreJ, MosgesR

Allergic rhinitis
Nasal polyps treatment
Rhinosinusitis treatment
Epistaxis
Nasal irritation

Intranasal corticosteroids (INCs) are effective and safe treatments for allergic rhinitis, rhinosinusitis, and nasal polyps. While some concerns exist about systemic side effects, a review of the literature indicates that INCs primarily have local side effects, such as nasal irritation and epistaxis, and have a favorable safety profile.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

12.

[A case of severe asthma responsive to omalizumab treatment despite a low serum IgE level and lack of sensitized allergens].

Author: SuginoYasuteru, SandaRyo, TakagiYasuyuki, KatoMotoaki, OhtaAkiko, OkumuraJunya, NagaiHideaki

Asthma treatment
Malaise
Weight gain

A case report demonstrates the therapeutic effect of omalizumab in a patient with severe intractable asthma and low serum IgE levels. Treatment with omalizumab led to significant improvement in asthma symptoms and reduced the need for oral corticosteroids.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Japanese

13.

Efficacy and safety of ciclesonide in the treatment of 24,037 asthmatic patients in routine medical care.

Author: VogelmeierClaus F, HeringThomas, LewinThomas, SanderPeter, BethkeThomas D

Improved asthma symptoms
Reduced asthma episodes
Adverse drug reactions

Ciclesonide is effective and well-tolerated in the treatment of mild to moderate bronchial asthma in a real-life setting. No unexpected adverse drug reactions were observed.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.

Language : English

15.

Once-daily ciclesonide via metered-dose inhaler: Similar efficacy and safety with or without a spacer.

Author: EngelstätterRenate, SzlávikM, GerberClaudia, BeckEkkehard

Improved asthma symptoms
Improved lung function
Reduced rescue medication use
Increased cortisol levels

Ciclesonide administered via metered-dose inhaler (MDI) alone or with a spacer showed similar efficacy and tolerability in patients with persistent asthma.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

16.

The safety profile of ciclesonide in the treatment of persistent asthma.

Author: CraigTimothy

Asthma control
Oropharyngeal adverse events
Systemic adverse events

Ciclesonide (CIC) is a new inhaled corticosteroid (ICS) with a favorable safety profile compared to other ICSs. A review of clinical trial data showed low incidence of oropharyngeal adverse events and minimal systemic activity, indicating potential benefits in managing asthma with fewer side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

17.

Similar efficacy of ciclesonide versus prednisolone to treat asthma worsening after steroid tapering.

Author: van den BergeM, ArshadS H, IndP W, MagnussenH, HamelmannE, KanniessF, PostmaD S

Improved asthma control
Rapid onset of action
Reduced cortisol suppression
None reported

Inhaled ciclesonide (800mug twice daily) was as effective as oral prednisolone (40mg once daily) in regaining asthma control in patients with asthma worsening, with a more rapid onset and smaller effect on cortisol suppression, suggesting a better safety profile.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

19.

Inhaled corticosteroids for asthma: are they all the same?

Author: BaptistA P, ReddyR C

Currently available inhaled corticosteroids (ICS) and their delivery systems differ in ways that can potentially affect both safety and therapeutic effectiveness for individual patients.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

20.

Ciclesonide: a closer look at its systemic and oropharyngeal safety profile.

Author: BergerWilliam E

Asthma treatment
Safety profile
Oropharyngeal adverse events

Ciclesonide, a novel inhaled corticosteroid (ICS), shows promise as a safe and effective treatment for asthma. It has a favorable safety profile with no observed effect on the hypothalamic-pituitary-adrenal (HPA) axis and a low incidence of oropharyngeal adverse events, making it a potential benefit for patients with asthma.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

21.

Effect of coadministered ketoconazole, a strong cytochrome P450 3A4 enzyme inhibitor, on the pharmacokinetics of ciclesonide and its active metabolite desisobutyryl-ciclesonide.

Author: BöhmerGabriele M, DrollmannAnton, GleiterChristoph H, NaveRüdiger

Drug interactions

Ketoconazole inhibits the metabolism of desisobutyryl-ciclesonide, the active metabolite of ciclesonide, indicating a potential drug interaction.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

23.

Comparison of twice-daily inhaled ciclesonide and fluticasone propionate in patients with moderate-to-severe persistent asthma.

Author: BatemanE D, LinnhofA E, HomikL, FreudensprungU, SmauL, EngelstätterR

Asthma control
Improved lung function
Improved quality of life
Reduced asthma symptoms
Reduced rescue medication use
Candidiasis
Dysphonia

Ciclesonide 320 microg and FP 330 microg administered twice daily over 6 months provided similar efficacy in patients with moderate or severe persistent asthma previously well-controlled by high doses of ICS at baseline. Ciclesonide was associated with fewer local AEs than FP.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

24.

A randomized study comparing ciclesonide and fluticasone propionate in patients with moderate persistent asthma.

Author: BouletLouis-Philippe, BatemanEric D, VovesRobert, MüllerThomas, WolfSusanne, EngelstätterRenate

Improved HRQoL
Improved lung function
Reduced asthma symptoms
Reduced oral candidiasis

Once-daily ciclesonide and twice-daily fluticasone propionate resulted in similar improvements in lung function in patients with moderate persistent asthma. Ciclesonide showed significant improvements in oral candidiasis and HRQoL over fluticasone.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

25.

Pharmacokinetic and pharmacodynamic properties of inhaled ciclesonide.

Author: DerendorfHartmut

Asthma control
Reduced side effects

This article reviews inhaled corticosteroids, with a focus on ciclesonide, a novel inhaled corticosteroid with a unique pharmacokinetic and pharmacodynamic profile. Ciclesonide's pulmonary activation and low oral deposition minimize oropharyngeal adverse events, while its low oral bioavailability and rapid clearance reduce systemic exposure.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

26.

Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy.

Author: RizzoMaria Cândida V, SoléDirceu

Asthma control
Improved pulmonary function
Reduced exacerbations
Growth decrease
Oral candidiasis

Inhaled corticosteroids (ICS) are effective in controlling asthma in children, reducing the number of exacerbations, medical consultations, hospitalizations, and the need for oral corticosteroid bursts. The most documented adverse effect is transitory decrease of growth rate.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

27.

Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma.

Author: DerendorfH, NaveR, DrollmannA, CerasoliF, WurstW

Asthma treatment
Bone density reduction
Coughing
Dysphonia
Fractures
Growth velocity reduction
Oropharyngeal candidiasis
Skin bruising
Skin thinning

This paper discusses the pharmacokinetic and pharmacodynamic effects of inhaled corticosteroids (ICS) in the treatment of asthma. The properties of ICS, including particle size, receptor affinity, and systemic clearance, influence their efficacy and safety profiles.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

28.

The systemic safety of inhaled corticosteroid therapy: a focus on ciclesonide.

Author: MeltzerEli O, DerendorfHartmut

Improved asthma control
Low systemic activity
None mentioned

Ciclesonide, an inhaled corticosteroid, demonstrated no clinically relevant effect on hypothalamic-pituitary-adrenal (HPA) axis function even at high doses. This suggests that ciclesonide may have an improved therapeutic margin compared with other inhaled corticosteroids.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

29.

[The optimal dosing times of corticoids].

Author: DridiDorra, Ben AttiaMossadok, AouamKarim, BouzouitaKamel, BoughattasNaceur A, ReinbergAlain

Asthma treatment
Side effects
Timing issues

Cortisol and its derivatives, anti-inflammatory corticoids, have time-related desirable and undesirable effects. Chronotherapeutic optimization can increase desirable effects and safety of corticoids in the treatment of adrenocortical failure, congenital adrenal hyperplasia and asthma. This study highlights the advantages of ciclesonide, a new inhaled corticoid, in the treatment of asthma.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : French

30.

A comparative study of inhaled ciclesonide 160 microg/day and fluticasone propionate 176 microg/day in children with asthma.

Author: PedersenS, Garcia GarciaM L, ManjraAl, TheronI, EngelstätterR

Asthma treatment
Side effects

This study compared the efficacy and safety of ciclesonide (CIC) with fluticasone propionate (FP) in children and adolescents with persistent asthma. Both treatments resulted in significant improvements in lung function, asthma symptoms, and rescue medication use, with comparable efficacy and safety profiles.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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