What is the comparison between beclomethasone (corticosteroid) and mometasone (corticosteroid) in terms of efficacy and safety?

Comparison of Beclomethasone and Mometasone

Mometasone furoate is the preferred intranasal corticosteroid over beclomethasone dipropionate, particularly for long-term use in children, as beclomethasone has demonstrated growth suppression at doses exceeding recommendations while mometasone has shown no effect on growth at recommended doses. 1

Efficacy Comparison

Equivalent Clinical Effectiveness

• Both agents demonstrate comparable efficacy for treating allergic rhinitis when used at recommended doses. 1
• Direct comparative trials show mometasone furoate 200 mcg once daily is as effective as beclomethasone dipropionate 200 mcg twice daily (400 mcg total) for controlling perennial allergic rhinitis symptoms, with both significantly superior to placebo. 2
• In seasonal allergic rhinitis, mometasone furoate 200 mcg once daily was equally effective as beclomethasone dipropionate 200 mcg twice daily, with 79% versus 74% of patients achieving complete or marked relief. 3
• The clinical response does not vary significantly between currently available intranasal corticosteroids, including both beclomethasone and mometasone. 1

Onset of Action

• Mometasone furoate demonstrates onset of therapeutic effect within approximately 7 hours in seasonal allergic rhinitis. 4
• Both agents fall within the 3-12 hour onset range typical for intranasal corticosteroids. 1

Safety Profile: Critical Differences

Growth Effects in Children (Most Important Distinction)

• Growth suppression from intranasal corticosteroids has been reported only with long-term use of beclomethasone dipropionate that exceeded recommended doses or when administered to toddlers. 1
• Studies with mometasone furoate have shown no effect on growth at recommended doses compared with placebo, even at doses up to twice the recommended amount. 1
• In yearlong stadiometry studies, beclomethasone dipropionate at twice the recommended daily dosage resulted in growth suppression, while mometasone furoate showed no effects on growth compared with placebo. 1
• In clinical practice, it is prudent to use intranasal steroid preparations that have not been shown to have any negative impact on growth in children, making mometasone the preferred choice. 1

Hypothalamic-Pituitary-Adrenal (HPA) Axis Effects

• Mometasone furoate has negligible bioavailability and less potential for systemic side effects, with no detectable effect on HPA axis function in studies up to 1 year in duration. 5, 4
• There is some evidence of HPA axis suppression specifically with beclomethasone nasal spray (note: betamethasone, not beclomethasone, but this highlights the class concern). 1
• Both agents, when given at recommended doses, are not generally associated with clinically significant systemic side effects. 1

Local Adverse Effects

• Both agents have similar local side effect profiles including nasal irritation, epistaxis, and pharyngitis. 4, 3
• Local side effects are rare with proper administration technique (spray directed away from the nasal septum). 1, 6
• The overall incidence of adverse events with mometasone furoate is similar to placebo and comparable to beclomethasone dipropionate. 4, 3

Dosing Convenience

Administration Frequency

• Mometasone furoate offers the advantage of once-daily dosing (200 mcg), while beclomethasone dipropionate typically requires twice-daily administration (200 mcg twice daily for 400 mcg total dose). 3, 2
• Once-daily dosing may improve adherence, particularly in chronic conditions like perennial allergic rhinitis. 2

Pregnancy Considerations

Safety Data in Pregnancy

• Both beclomethasone and mometasone are FDA Pregnancy Category C (beclomethasone has more accumulated safety data). 1
• Beclomethasone has more extensive human pregnancy data and is considered reasonable to continue if it adequately controlled symptoms before pregnancy. 1
• If starting intranasal corticosteroids during pregnancy, budesonide (Pregnancy Category B) may be preferred over either beclomethasone or mometasone due to more extensive human safety data. 1
• A meta-analysis concluded that intranasal corticosteroids during pregnancy do not increase risk of major malformations, preterm delivery, low birth weight, or pregnancy-induced hypertension. 1

Special Populations

Chronic Rhinosinusitis with Nasal Polyps

• Both fluticasone propionate, budesonide, and mometasone furoate show beneficial effects on symptom score reduction without significant differences among corticosteroid types. 1
• Mometasone furoate is effective for chronic rhinosinusitis when used long-term. 1

Inflammatory Bowel Disease (Different Formulation)

• Beclomethasone dipropionate (oral formulation) has been studied for ulcerative colitis, showing non-inferiority to prednisone with similar adverse event rates. 1
• This represents a different clinical application and formulation than intranasal use. 1

Clinical Bottom Line

Choose mometasone furoate over beclomethasone dipropionate for:

• Any pediatric patient requiring long-term intranasal corticosteroid therapy (no growth suppression demonstrated). 1
• Patients preferring once-daily dosing for improved adherence. 3, 2
• Initial therapy in treatment-naive patients. 1

Beclomethasone dipropionate may be continued if:

• A patient is already well-controlled on this agent before pregnancy (more accumulated pregnancy data). 1
• Cost considerations are paramount and the patient is an adult (though this should not override safety concerns in children). 1

Common Pitfalls to Avoid

• Never exceed recommended doses of beclomethasone dipropionate in children, as this is the only intranasal corticosteroid associated with documented growth suppression. 1
• Ensure proper nasal spray technique with spray directed away from the nasal septum to minimize epistaxis and septal perforation risk. 1, 6
• Monitor children on any intranasal corticosteroid periodically for growth, even with agents not associated with growth suppression in trials. 1
• Do not assume all intranasal corticosteroids have identical safety profiles—the evidence clearly distinguishes mometasone's superior safety profile in children. 1