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0 0.5 1 1.5 2+ Case 33% Improvement Relative Risk Budesonide for COVID-19  Lee et al.  Prophylaxis Does budesonide reduce COVID-19 infections? Retrospective 7,019 patients in South Korea Fewer cases with budesonide (not stat. sig., p=0.098) Lee et al., Research Square, September 2021 Favors budesonide Favors control

Association Between Inhaled Corticosteroid Use and the Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Nationwide Population-based Study in South Korea

Lee et al., Research Square, doi:10.21203/
Sep 2021  
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Retrospective 44,968 patients in South Korea, 7,019 on inhaled corticosteroids, showing no statistically significant differences in COVID-19 cases.
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.
risk of case, 32.6% lower, RR 0.67, p = 0.10, treatment 19 of 1,674 (1.1%), control 95 of 5,345 (1.8%), NNT 156, adjusted per study, odds ratio converted to relative risk, multivariate.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Lee et al., 9 Sep 2021, retrospective, South Korea, preprint, 5 authors.
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Association Between Inhaled Corticosteroid Use and the Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Nationwide Population-based Study in South Korea
Sang Chul Lee, Kang Ju Son, Chang Hoon Han, Ji Ye Jung, Seon Cheol Park
Background Inhaled corticosteroid (ICS) use may increase the risk of respiratory infection, but its in uence on the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is not known. This study aimed to investigate the association between ICS use and the risk of SARS-CoV-2 infection among the patients with chronic respiratory diseases. Methods The Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea provided nationwide data of 44,968 individuals with chronic respiratory diseases tested for SARS-CoV-2 until May 15. The risks of SARS-CoV-2 infection were retrospectively analysed according to the prescription, type, and dose of ICS taken one year before SARS-CoV-2 test. Results Among 44,968 individuals tested, 931 (2.1%) were positive for SARS-CoV-2. A total of 7,019 patients (15.6%) were prescribed ICS one year prior to being tested for SARS-CoV-2. Low, medium, and high doses of ICS were prescribed in 7.5%, 1.6%, and 6.5% of total cases, respectively. Among the types of ICS, budesonide, uticasone, beclomethasone, and ciclesonide were prescribed in 3.7%, 8.9%, 2.3%, and 0.6% of total cases, respectively. The multivariate analysis showed no signi cant increase in infection with ICS use (OR, 0.84; 95% CI, 0.66-1.03). Moreover, there were no associations between the risk of infection, and doses or types of ICS prescribed. Conclusion Prior ICS use did not increase the risk of SARS-CoV-2 infection. Moreover, different doses or types of ICS did not affect the risk. This study supports the current guidelines to manage patients taking ICS during the SARS-CoV-2 pandemic.
Declarations Ethics approval and consent to participate: This study was approved by the Institutional Review Board of the National Health Insurance Service of the Ilsan Hospital and adhered to the tenets of the Declaration of Helsinki (NHIMC 2020-04-008). Written informed consent was waived as the data were de-identi ed in the database used. Consent for publication: Not Con icts of interest: The authors declare that they have no relevant con icts of interest. Author's contributions: Supplementary Files This is a list of supplementary les associated with this preprint. Click to download. COVID19andICSRespiratoryResearchSuppl.docx
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