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All Studies   Meta Analysis    Recent:   

Intranasal Corticosteroids Are Associated with Better Outcomes in Coronavirus Disease 2019

Strauss et al., The Journal of Allergy and Clinical Immunology: In Practice, doi:10.1016/j.jaip.2021.08.007
Aug 2021  
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Mortality 24% Improvement Relative Risk ICU admission 22% Hospitalization 19% Budesonide for COVID-19  Strauss et al.  Prophylaxis Is prophylaxis with budesonide beneficial for COVID-19? Retrospective 72,147 patients in the USA (April 2020 - March 2021) Lower mortality (p=0.013) and ICU admission (p=0.0034) c19early.org Strauss et al., The J. Allergy and Cli.., Aug 2021 Favorsbudesonide Favorscontrol 0 0.5 1 1.5 2+
Budesonide for COVID-19
18th 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.
4,300+ studies for 75 treatments. c19early.org
Retrospective 72,147 COVID-19+ patients in the USA, showing lower mortality, ICU admission, and hospitalization with intranasal corticosteroid use.
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 death, 23.5% lower, RR 0.76, p = 0.01, treatment 231 of 10,187 (2.3%), control 1,649 of 61,960 (2.7%), NNT 254, adjusted per study, odds ratio converted to relative risk, PSM.
risk of ICU admission, 22.3% lower, RR 0.78, p = 0.003, treatment 376 of 10,187 (3.7%), control 2,559 of 61,960 (4.1%), adjusted per study, odds ratio converted to relative risk, PSM.
risk of hospitalization, 18.9% lower, RR 0.81, p < 0.001, treatment 1,676 of 10,187 (16.5%), control 10,932 of 61,960 (17.6%), adjusted per study, odds ratio converted to relative risk, PSM.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Strauss et al., 23 Aug 2021, retrospective, USA, peer-reviewed, 8 authors, study period 1 April, 2020 - 31 March, 2021.
This PaperBudesonideAll
Intranasal Corticosteroids Are Associated with Better Outcomes in Coronavirus Disease 2019
MD a , Ronald Strauss, RN, MSN a , Nesreen Jawhari, MD Amy H Attaway, PhD Bo Hu, MD c , Lara Jehi, Alex Milinovich, MD Victor E Ortega, MD, PhD Joe G Zein
The Journal of Allergy and Clinical Immunology: In Practice, doi:10.1016/j.jaip.2021.08.007
What is already known about this topic? Severe acute respiratory syndrome coronavirus 2 sites of entry are highly expressed in nasal epithelial cells. What does this article add to our knowledge? Intranasal corticosteroid (INCS) therapy is associated with a lower risk for coronavirus disease 2019 (COVID-19)-related hospitalization, admission to the intensive care unit, and in-hospital mortality. How does this study impact current management guidelines? Although our findings suggest a potential beneficial role for INCS use, randomized control trials are needed to determine if INCS reduces the risk for severe outcomes related to COVID-19. BACKGROUND: Sites of entry for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are highly expressed in nasal epithelial cells; however, little is known about the impact of intranasal corticosteroids (INCS) on coronavirus disease 2019 (COVID-19)-related outcomes. OBJECTIVE: To determine the association between baseline INCS use and COVID-19-related outcomes. METHODS: Using the Cleveland Clinic COVID-19 Research Registry, we performed a propensity score matching for treatment with INCS before SARS-CoV-2 infection (April 1, 2020, to March 31, 2021). Of the 82,096 individuals who tested positive, 72,147 met inclusion criteria. Our endpoints included the need for hospitalization, admission to the intensive care unit (ICU), or in-hospital mortality. RESULTS: Of the 12,608 (17.5%) who were hospitalized, 2935 (4.1%) required ICU admission and 1880 (2.6%) died during hospitalization. A significant proportion (n [ 10,187; 14.1%) were using INCS before SARS-CoV-2 infection. Compared with nonusers, INCS users demonstrated lower risk for hospitalization (adjusted odds ratio [OR] [95% confidence interval (CI)]: 0.78 [0.72; 0.85]), ICU admission (adjusted OR [95% CI]: 0.77 [0.65; 0.92]), and in-hospital mortality (adjusted OR [95% CI]: 0.76 [0.61; 0.94]). These findings were replicated in sensitivity analyses where patients on inhaled corticosteroids and those with allergic rhinitis were excluded. The beneficial effect of INCS was significant after adjustment for baseline blood eosinophil count (measured before SARS-CoV-2 testing) in a subset of 30,289 individuals. CONCLUSION: INCS therapy is associated with a lower risk for COVID-19-related hospitalization, ICU admission, or death. Future randomized control trials are needed to determine if INCS reduces the risk for severe outcomes related to COVID-19.
ONLINE REPOSITORY APPENDIX E1: DESCRIPTION OF THE REGISTRY The Cleveland Clinic COVID-19 Research Registry (CCCRR) This study uses the CCCRR, which includes all patients tested for SARS-CoV-2 at the Cleveland Clinic Healthcare System (CCHS). Data on patients' demographics, medications, comorbidities, history of SARS-CoV-2 exposure, national and international travel, disease manifestation on presentation, socioeconomic status, COVID-19-related therapy, disposition, and outcomes were extracted from electronic health records (EHR). E1 In addition, data related to hospitalization, critical care needs, and outcome were extracted for patients requiring hospitalization. Registry characterization and data collection reflect the clinical characteristics previously published on COVID-19. E2-E6 Uniform clinical templates were implemented across the CCHS using EHR to standardize the care of patients tested for SARS-CoV-2 and to facilitate data extraction. Data extraction from EHR (Epic; Epic Systems Corporation, Wisc) at the CCHS was performed manually by a trained research team and electronically using predefined processes that have been previously published. E7 This study and the CCCRR were both approved by the Cleveland Clinic Institutional Review Board (IRB #20-283 and 20-391). COVID-19 testing protocols
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