Inhaled steroids keep COVID-19 patients with mild to moderate illness out of hospital – UB Now : News and opinions for UB faculty and staff

A national study led by UB emergency medicine physicians found that patients with mild to moderate COVID-19 treated with an inhaled steroid are significantly less likely to require emergency care or hospitalization due to COVID-19 than patients treated with placebo .

The results of the double-blind, randomized, controlled study were published Nov. 22 in JAMA Internal Medicine. Participants were registered from June to November 2020.

A total of 400 patients from 10 centers in the US were enrolled, about half of whom received treatment and half a placebo. Forty-seven patients came from the Buffalo area.

Participants treated with ciclesonide did not see a faster reduction in their symptoms β€” the study’s primary endpoint β€” than those who received placebo, with both groups seeing all symptoms disappear within 19 days on average. For this study, COVID-19 symptoms were defined as cough, dyspnea (shortness of breath), chills, fever, repeated tremors with chills, muscle aches, headache, sore throat, and new loss of taste or smell.

However, patients treated with ciclesonide were less likely to require emergency care or hospitalization for reasons attributable to COVID-19. In this study, only 1% of patients receiving ciclesonide required emergency care or hospitalization due to COVID-19, compared to 5.4% of patients receiving placebo.

This effect on emergency care and hospital admissions was an important secondary endpoint of the study.

“Our study did not show that ciclesonide relieved symptoms faster,” said Brian M. Clemency, the paper’s lead author and professor of emergency medicine in the Jacobs School of Medicine and Biomedical Sciences at UB, “but the treated group was less likely than those treated with placebo to go to the emergency department or be hospitalized, which is significant.

β€œAny COVID-19 treatment that can reduce the number of emergency room visits or hospitalizations will benefit not only the patient, but also the health care system and the community at large.”

Clemency is a physician with UBMD Emergency Medicine based at the Erie County Medical Center.

While much COVID-19 research has appropriately focused on patients with severe disease, Clemency and his colleagues were interested in studying mild to moderate cases. He explains that mild to moderate cases of COVID-19 make up the majority of cases and may be responsible for a significant degree of spread in the community.

Since the study was conducted before the emergence of new SARS-CoV2 variants, it does not address the potential effects of the treatment on those infected by new variants, such as delta, but Clemency notes that it would be reasonable to to assume that ciclesonide would benefit them. good.

“The study did not address the delta variant, but there is no reason to assume that infections caused by delta would be fundamentally different,” he says.

While the study did not address which patients in particular would benefit from ciclesonide, Clemency points out that the findings suggest that this drug may provide a benefit for some patients with mild to moderate COVID-19.

“For patients at high risk of developing severe COVID-19, ciclesonide may be an inexpensive, low-risk treatment that can be taken at home,” he says.

Inhaled corticosteroids have been seen as potentially beneficial in the treatment of COVID-19 because they reduce inflation and target key proteins involved in virus replication.

Ciclesonide is approved for the long-term treatment of asthma as maintenance therapy in patients 12 years of age and older in the US and older than 6 years of age in Canada. In vitro studies have shown that ciclesonide blocks COVID-19 viral replication and has antiviral properties against COVID-19.

Co-authors are Renoj Varughese, also of the Jacobs School’s Department of Emergency Medicine; Yaneicy Gonzalez-Rojas of Verus Clinical Research Corporation; Caryn G. Morse of Wake Forest School of Medicine; Wanda Phipatanakul, Boston Children’s Hospital, Harvard Medical School; David J. Koster, Instat Clinical Research; and Michael S. Blaiss, Medical College of Georgia at Augusta University.

Funding was provided by Covis Pharma, which manufactures ciclesonide, and UB’s Clinical and Translational Science Institute through the National Center for Advancing Translational Science and the National Heart, Lung, and Blood Institute of the National Institutes of Health.

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