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All Studies   Meta Analysis    Recent:   

To estimate the efficacy of inhaled corticosteroid in-patient of moderate COVID-19 pneumonia - randomized controlled study

Dhanger et al., Int J Acad Med Pharm, doi:10.47009/jamp.2023.5.5.101, REF/2021/09/046997
Sep 2023  
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Mortality 43% Improvement Relative Risk ICU admission 78% Recovery 70% Budesonide  Dhanger et al.  LATE TREATMENT  RCT Is late treatment with budesonide beneficial for COVID-19? RCT 80 patients in India (January - March 2022) Lower ICU admission (p<0.0001) and improved recovery (p<0.0001) Dhanger et al., Int J Acad Med Pharm, Sep 2023 Favorsbudesonide Favorscontrol 0 0.5 1 1.5 2+
Budesonide for COVID-19
19th treatment shown to reduce risk in April 2021
*, now with p = 0.0000011 from 15 studies, recognized in 8 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments.
RCT inhaled budesonide with 80 moderate COVID-19 pneumonia patients. The budesonide group had significantly faster time to clinical improvement, fewer ICU admissions, shorter oxygen therapy duration, and lower mortality. Inhaled budesonide 400mcg twice daily for 14 days.
risk of death, 42.9% lower, RR 0.57, p = 0.52, treatment 4 of 40 (10.0%), control 7 of 40 (17.5%), NNT 13.
risk of ICU admission, 78.3% lower, RR 0.22, p < 0.001, treatment 5 of 40 (12.5%), control 23 of 40 (57.5%), NNT 2.2.
risk of no recovery, 70.0% lower, RR 0.30, p < 0.001, treatment 9 of 40 (22.5%), control 30 of 40 (75.0%), NNT 1.9.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Dhanger et al., 30 Sep 2023, Randomized Controlled Trial, India, peer-reviewed, 4 authors, study period January 2022 - March 2022, trial REF/2021/09/046997.
This PaperBudesonideAll
Sangeeta Dhanger, Pratheeba Natrajan, Ravindra Bhat, Dr Bhavani Vaidiyanathan
Background: Systemic corticosteroids have been found to reduce the mortality in patients with moderated and severe COVID-19 pneumonia in the first and second waves of the pandemic but had the unwanted effects which can be avoided when the corticosteroids are given via the inhalational route (ICS). Therefore in this study, we aimed to investigate whether Inhaled Corticosteroid MDI -Budesonide could reduce the morbidity in patients with moderate COVID-19 pneumonia. Our primary objective was to study the time to clinical improvement in days (Time Frame: Up to 14 days)defined as the resolution of all systemic and respiratory symptoms (SPO2 > 92% in room air, RR 14-16/min, for ≥2 consecutive days). Materials and Methods: After obtaining approval from Institute Research and Ethics committee and following CTRI registration, this randomized controlled study was carried out from January to March 2022 in a covid dedicated hospital. Eighty participants were enrolled and written informed consent was obtained. The study interventions began within 6-12 h of confirmation of diagnosis with RT PCR report and CT scan of thorax (CORAD Score 2-3) of moderate COVID 19. Participants were randomized by the computer-generated random number table and were divided in to two groups: S (Intervention) group and C (control) group. Both the groups received the Covid 19 care as per the hospital treatment protocol. In addition, participants of Group S received Inhaled Budesonide MDI (metered dose inhaler) 2 puff (400mcg) two times in a day for 14 days. All patients were hourly monitored and following parameters were recorded daily for 14 days: GCS, HR, NIBP, SPO2, HR, Temperature, mode of Oxygen therapy: (FM/ VM/ NRBM/ NIV/ IV) and FIO2. Study end point may be before 14 days incase of patient was shifted to ICU due to requirement of mechanical ventilation or incase of adverse outcome within 14 days. Result: The results of this study showed that budesonide nebulization significantly reduced morbidity as there were significant difference between both the group in the number of days requirement of oxygen in Group C 31± 5 days and Group S 7 ± 4 days, number of patient shifted to ICU in Group C 23 and Group S 5 and number of patients expired in Group C 13 and Group S only 4. Discussion is Budesonide is an inhaled glucocorticoid, which inhibits a variety of inflammatory cells, reduces the production of inflammatory mediators and consequently has a significant antiinflammatory effect. Compared to systemic glucocorticoids, budesonide inhalation has the following advantages; high concentration primarily in the lungs, high hepatic clearance, and high glucocorticoid receptor affinity. During nebulization, the nebulizer unit breaks the liquid into micro-particles, which are directly inhaled into the lower respiratory tract and rapidly absorbed by the pulmonary mucosa, thus increasing the local drug concentration. Conclusion: Inhaled budesonide in patient with moderate covid pneumonia..
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Late treatment
is less effective
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