Budesonide for COVID-19

27th treatment shown to reduce risk in September 2021, now with p = 0.000003 from 15 studies, recognized in 10 countries.

Lower risk for mortality, ICU, hospitalization, progression, recovery, and cases. 

No treatment is 100% effective.
Protocols combine treatments.

c19early.org

Meta-analysis

Estimated 30 patient budesonide early treatment RCT with results not reported over 6 years after estimated completion.

4 budesonide RCTs have results missing long after expected1-4
The trials report a total of 916 patients, with 1 trial having actual enrollment of 146, and the remainder estimated.

Important missing comments or errors? Let us know.

1. Marcy et al., Early Treatment of Vulnerable Individuals With Non-Severe SARS-CoV-2 Infection: A Multi-Arm Multi-Stage Randomized Trial (MAMS) to Evaluate the Effectiveness of Several Specific Treatments in Reducing the Risk of Clinical Worsening or Death in Sub-Saharan Africa (COVERAGE-Africa), NCT04920838, clinicaltrials.gov/study/NCT04920838clinicaltrials.gov.

2. Korea United Pharm., A Multi-center, Randomized, Double-blind, Placebo-controlled, Parallel, Phase 2 Study to Evaluate the Efficacy and Safety of UI030 in COVID-19 Patients, NCT05055414, clinicaltrials.gov/study/NCT05055414clinicaltrials.gov.

3. Taille et al., Protective Role of Inhaled Steroids for Covid-19 Infection, NCT04331054, clinicaltrials.gov/study/NCT04331054clinicaltrials.gov.

4. Afazeli et al., Evaluation of Efficacy of Pharmacotherapy Treatment of COVID-19 Infection Using Oral Levamisole and Formoterol+Budesonide Inhaler and Comparison of This Treatment Protocol With Standard National Treatment of the Disease, NCT04331470, clinicaltrials.gov/study/NCT04331470clinicaltrials.gov.

Afazeli et al., 20 May 2020, Double Blind Randomized Controlled Trial, Iran, trial NCT04331470 (history). Contact: Dr.afazeli@gmail.com, farjam.md@gmail.com, info@fums.ac.ir.

Outcome (studies)

Improvement

Relative risk · 95% CI

All studies (15)27%

Mortality (11)25%

Ventilation (2)15%

ICU admission (2)67%

Hospitalization (5)28%

Progression (3)52%

Recovery (5)40%

Cases (2)25%

RCTs (7)40%

RCT mortality (5)20%

Prophylaxis (4)27%

Early (3)73%

Late (8)24%

after exclusions

00.511.5+

← Budesonide
reduces riskIncreased
risk →

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Most accessed treatments

Antiviral effects

Vitamins & Minerals

Host endosomal entry / trafficking

Dual-action mAbs

RdRp

Nasal & Oral Sprays / Rinses

Analgesics

Antiandrogens

Host targets and pathways

Inflammatory and immune modulation

Mpro (Gen 1)

Oxidative stress and cytoprotection

Lifestyles

TMPRSS2

Spike neutralization

Replication inhibition (target unresolved)

COVID-19 mAbs

Pleiotropic modulation

Attachment / entry inhibition

Mpro (Gen 2)

H1RAs

Nutrients and microbiome support

Host mAbs

IL-6 / IL-6R blockade

Physical and extracorporeal interventions

Natural products and extracts

Symptom management

Unconfirmed antiviral rationale

Lifestyle, behaviors, and exposure prevention

Other complication management

Mpro / 3CLpro

Host pyrimidine synthesis

Direct viral inactivation

Endothelial / vascular protection

Direct respiratory tract treatments

Other antibodies, proteins, peptides, cells, and RNA therapies

Secondary infection and coinfection management

Evaluation of Efficacy of Pharmacotherapy Treatment of COVID-19 Infection Using Oral Levamisole and Formoterol+Budesonide Inhaler and Comparison of This Treatment Protocol With Standard National Treatment of the Disease

Budesonide for COVID-19