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0 0.5 1 1.5 2+ Mortality 32% Improvement Relative Risk Mortality, day 30 47% Budesonide  Al Sulaiman et al.  ICU PATIENTS Is very late treatment with budesonide beneficial for COVID-19? PSM prospective study of 130 patients in Saudi Arabia (Mar 2020 - Mar 2021) Lower mortality with budesonide (not stat. sig., p=0.13) Al Sulaiman et al., J. Intensive Care .., Nov 2021 Favors budesonide Favors control

The Role of Inhaled Corticosteroids (ICS) in Critically Ill Patients With COVID-19: A Multicenter, Cohort Study

Al Sulaiman et al., Journal of Intensive Care Medicine, doi:10.1177/08850666211053548
Nov 2021  
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Budesonide for COVID-19
18th treatment shown to reduce risk in April 2021
*, now known with p = 0.000025 from 14 studies, recognized in 8 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,100+ studies for 60+ treatments.
Combined retrospective (Mar-Jun 2020) and prospective (until Mar 2021) study of 954 COVID+ ICU patients in Saudi Arabia, 68 treated with ICS (80% budesonide or budesonide/formoterol, 20% fluticasone/salmeterol), showing lower mortality with treatment, statistically significant for 30-day but not in-hospital mortality.
Targeted administration to the respiratory tract provides treatment directly to the typical source of initial SARS-CoV-2 infection and replication, and allows for rapid onset of action, higher local drug concentration, and reduced systemic side effects (early treatment may be more beneficial).
risk of death, 32.0% lower, HR 0.68, p = 0.13, treatment 30 of 64 (46.9%), control 31 of 64 (48.4%), adjusted per study, in-hospital mortality, propensity score matching, multivariable, Cox proportional hazards.
risk of death, 47.0% lower, HR 0.53, p = 0.03, treatment 25 of 65 (38.5%), control 29 of 65 (44.6%), adjusted per study, propensity score matching, multivariable, Cox proportional hazards, day 30.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Al Sulaiman et al., 10 Nov 2021, prospective, Saudi Arabia, peer-reviewed, 80% of treatment patients used budesonide, mean age 61.4, 24 authors, study period 1 March, 2020 - 31 March, 2021. Contact:
This PaperBudesonideAll
The Role of Inhaled Corticosteroids (ICS) in Critically Ill Patients With COVID-19: A Multicenter, Cohort Study
Khalid Al Sulaiman, PharmD, BCCCP Ohoud Aljuhani, PharmD Kholoud Al Aamer, PharmD Omar Al Shaya, PharmD, BCCCP Abdulrahman Al Shaya, MD Alawi S Alsaeedi, PharmD Alaa Alhubaishi, PharmD, BCPS Ali F Altebainawi, PharmD Alaa Al Harthi, PharmD Shorouq Albelwi, PharmD Rahaf Almutairi, PharmD Norah Alsubaie, PharmD Alanoud Alsallum, PharmD Ghazwa B Korayem, PharmD Amjaad Alfahed, PharmD Raed Kensara, MD Elaf F Altebainawi, PharmD Raghdah S Alenezi, MD Thamer Alsulaiman, PharmD Huda Al Enazi, PhD Statistics Ramesh Vishwakarma, MD Tarek Al Dabbagh, MD Umar Bakhsh, MD Ghassan Al Ghamdi
Journal of Intensive Care Medicine, doi:10.1177/08850666211053548
Background: Severe coronavirus disease 2019 (COVID-19) can boost the systematic inflammatory response in critically ill patients, causing a systemic hyperinflammatory state leading to multiple complications. In COVID-19 patients, the use of inhaled corticosteroids (ICS) is surrounded by controversy regarding their impacts on viral infections. This study aims to evaluate the safety and efficacy of ICS in critically ill patients with COVID-19 and its clinical outcomes. Method: A multicenter, noninterventional, cohort study for critically ill patients with COVID-19 who received ICS. All patients aged ≥ 18 years old with confirmed COVID-19 and admitted to intensive care units (ICUs) between March 1, 2020 and March 31, 2021 were screened. Eligible patients were classified into two groups based on the use of ICS ± long-acting beta-agonists (LABA) during ICU stay. Propensity score (PS)-matched was used based on patient's Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, systemic corticosteroids use, and acute kidney injury (AKI) within 24 h of ICU admission. We considered a P-value of < 0.05 statistically significant. Results: A total of 954 patients were eligible; 130 patients were included after PS matching (1:1 ratio). The 30-day mortality (hazard ratio [HR] [95% confidence interval [CI]]: 0.53 [0.31, 0.93], P-value = 0.03) was statistically significant lower in patients who received ICS. Conversely, the in-hospital mortality, ventilator-free days (VFDs), ICU length of stay (LOS), and hospital LOS were not statistically significant between the two
Author's Contribution Khalid Al Sulaiman: conceptualization, methodology, software, data curation, writing -0riginal draft preparation, coordination, and management, visualization, investigation. Ohoud Aljuhani: conceptualization, literature review, methodology, investigation, data acquisition and processing, supervision, research coordination, and management, revising and editing the manuscript. Kholoud Al Aamer: data acquisition, data analysis, data processing, data preparation, and original draft writing. Omar Al Shaya: data acquisition, data analysis, data processing, data preparation, interpretation of the data and original draft writing. Abdulrahman Al Shaya: data acquisition, data analysis, data processing, data preparation, interpretation of the data and original draft writing. Alawi S. Alsaeedi: data acquisition, data analysis, data processing, data preparation, interpretation of the data and original draft writing. Alaa Alhubaishi: data curation, writing-original draft, revising and editing the manuscript, visualization, investigation and data interpretation. Ali F. Altebainawi: methodology, software, data curation, revising and editing the manuscript, supervision, visualization, investigation. Alaa Al Harthi: data acquisition, data analysis, data processing, data preparation, and original draft writing. Shorouq Albelwi: data acquisition, data analysis, data processing, data preparation, and original draft writing. Rahaf Almutairi: data acquisition, data analysis,..
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Late treatment
is less effective
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