Inhaled and intranasal ciclesonide for the treatment of COVID-19 in adult outpatients

1. In patients COVID-19, the combination of inhaled and intranasal ciclesonide did not show a statistically significant improvement of respiratory symptoms.

Evidence Rating Level: 1 (Excellent)

COVID-19 has represented a significant cause of morbidity and mortality since its emergence. Respiratory symptoms tend to be commonly present in those infected with this virus. Ciclesonide is a corticosteroid used in inhaled form to treat asthma and intranasally to treat allergic rhinitis. This randomised controlled trial aimed to evaluate whether early administration of ciclesonide decreases respiratory symptoms in adults with COVID-19. 203 participants were randomized to either inhaled and intranasal ciclesonide (n=105) or inhaled and intranasal saline placebo (n=98). The median age of participants was 35 years (interquartile range 27 – 46 years) and 109 (54%) were female. All included participants had confirmed covid-19 and at least one of the following symptoms: fever, cough, shortness of breath, chest congestion, or chest tightness). The primary outcome was defined as resolution of self-reported fever and all respiratory symptoms at day 7 of treatment. It was found that the proportion of participants with resolved symptoms by day 7 did not differ significantly between the intervention group (n = 42 from 105; 40%) and control group (n = 34 from 98; 35%). The adjusted risk difference was 5.5% (95% CI, -7.8% – 18.8%). The secondary outcomes included were hospital admission, death due to COVID-19, and resolution of symptoms by day 14. There were no statistically significant differences found in any of these outcomes. No deaths occurred during this study. 69 of 105 (66%) patients had resolution in the intervention group compared to 57 of 98 (58%) in placebo group, with an adjusted risk difference of 7.5% (95% CI, -5.9% – 20.8%). Therefore, the study concluded that younger healthier populations with COVID-19 did not improve respiratory symptoms. As this is one of the only trials focusing on this population, future directions for research should include examining different classes of inhaled corticosteroids to determine their effects.

Click to read the study in BMJ

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