Ciclesonide is a glucocorticoid receptor agonist indicated for the treatment of allergic rhinitis (Omnaris nasal spray) and asthma (Alvesco). It was also developed by Byk Gulden for chronic obstructive pulmonary disease (COPD), but no development had been reported for this indication since 1999. Ciclesonide is a pro-drug and rapidly metabolized to C21-desisobutyryl-ciclesonide which is more potent toward GR receptor than the parent drug.

Fluticasone propionate, a medium-potency synthetic corticosteroid, is used topically to relieve inflammatory and pruritic symptoms of dermatoses and psoriasis, intranasally to manage symptoms of allergic and non-allergic rhinitis, and orally for the treatment of asthma. Fluticasone proprionate is marketed under several different brand names such as Flonase®. Fluticasone propionate is also available as a combination product of azelastine hydrochloride and fluticasone propionate called Dymista™. Dymista™ is indicated in patients over 12 years old for symptomatic relief of seasonal allergic rhinitis. Fluticasone propionate binds to the glucocorticoid receptor. Unbound corticosteroids cross the membranes of cells such as mast cells and eosinophils, binding with high affinity to glucocorticoid receptors (GR). The results include alteration of transcription and protein synthesis, a decreased release of leukocytic acid hydrolases, reduction in fibroblast proliferation, prevention of macrophage accumulation at inflamed sites, reduction of collagen deposition, interference with leukocyte adhesion to the capillary wall, reduction of capillary membrane permeability and subsequent edema, reduction of complement components, inhibition of histamine and kinin release, and interference with the formation of scar tissue. In the management of asthma, the glucocorticoid receptor complexes down-regulates proinflammatory mediators such as interleukin-(IL)-1, 3, and 5, and up-regulates anti-inflammatory mediators such as IkappaB [inhibitory molecule for nuclear factor kappaB1], IL-10, and IL-12. The antiinflammatory actions of corticosteroids are also thought to involve inhibition of cytosolic phospholipase A2 (through activation of lipocortin-1 (annexin)) which controls the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes.

Rofleponide is a third generation synthetic glucocorticosteroid. This compound has high affinity for the rat thymus glucocorticoid receptor and showed a very high biotransformation rate in the human liver. Rofleponide was being investigated for its anti-inflammatory, immunosuppressive and anti-anaphylactic activity. It was evaluated in phase II clinical trials for its safety and efficacy in allergic rhinitis and asthma, and in a preclinical study for use in inflammatory bowel disease, but development of this drug was discontinued. Rofleponide was never marketed.

Rofleponide is a third generation synthetic glucocorticosteroid. This compound has high affinity for the rat thymus glucocorticoid receptor and showed a very high biotransformation rate in the human liver. Rofleponide was being investigated for its anti-inflammatory, immunosuppressive and anti-anaphylactic activity. It was evaluated in phase II clinical trials for its safety and efficacy in allergic rhinitis and asthma, and in a preclinical study for use in inflammatory bowel disease, but development of this drug was discontinued. Rofleponide was never marketed.