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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