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All Studies   Meta Analysis    Recent:   

Clinical efficacy of inhaled corticosteroids in patients with coronavirus disease 2019: A living review and meta-analysis

Nov 2023  
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Hospitalization, budesonide 55% Improvement Relative Risk Recovery, budesonide 25% Budesonide for COVID-19  Yu et al.  META ANALYSIS c19early.org 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 81 treatments. c19early.org
Systematic review and meta-analysis of 8 randomized controlled trials (2,788 patients) comparing inhaled corticosteroids (ICS) to placebo or usual care for the treatment of COVID-19. Overall, ICS treatment was associated with improved clinical recovery at 7 days (risk ratio 1.20) and 14 days (risk ratio 1.21), but improvements for hospitalization, mortality, ICU admission, and ventilation were not statistically significant. In subgroup analyses, the ICS budesonide improved clinical recovery but ciclesonide did not.
There are significant differences between budesonide and ciclesonide that may contribute to the lower efficacy of ciclesonide. Pharmacokinetics and pharmacodynamics: budesonide has a more rapid onset of action and a shorter half-life, which can lead to a more immediate and potent anti-inflammatory effect. Ciclesonide is a prodrug that requires conversion to its active form, which may delay therapeutic effects. Receptor affinity and potency: budesonide has a higher affinity for glucocorticoid receptors and a higher potency compared to ciclesonide. This can result in more effective suppression of inflammation and immune modulation in the respiratory tract, potentially leading to better clinical outcomes. Bioavailability: budesonide typically has higher lung bioavailability compared to ciclesonide.
2 meta analyses show significant improvement with budesonide for recovery1,2.
Currently there are 15 budesonide for COVID-19 studies, showing 26% lower mortality [15‑36%], 15% lower ventilation [-73‑58%], 67% lower ICU admission [28‑85%], 29% lower hospitalization [10‑43%], and 25% fewer cases [14‑35%].
risk of hospitalization, 55.0% lower, RR 0.45, p = 0.26.
risk of no recovery, 24.8% lower, RR 0.75, p < 0.001, inverted to make RR<1 favor treatment.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Yu et al., 28 Nov 2023, peer-reviewed, 7 authors.
This PaperBudesonideAll
Clinical efficacy of inhaled corticosteroids in patients with coronavirus disease 2019: A living review and meta-analysis
Su-Yeon Yu, Miyoung Choi, Seungeun Ryoo, Chelim Cheong, Kyungmin Huh, Young Kyung Yoon, Su Jin Jeong
PLOS ONE, doi:10.1371/journal.pone.0294872
Inhaled corticosteroids are known to be relatively safe for long-term use in inflammatory respiratory diseases and it has been repurposed as one of the potential therapies for outpatients with coronavirus disease 2019 (COVID-19). However, inhaled corticosteroids have not been accepted for COVID-19 as a standard therapy because of its lack of proven benefits. Therefore, this study aimed to evaluate the effectiveness of inhaled corticosteroids in patients with COVID-19. Randomized controlled trials comparing the efficacy of inhaled corticosteroid treatment in patients with COVID-19 were identified through literature electronic database searches up to March 10, 2023. Meta-analyses were conducted for predefined outcomes, and the certainty of evidence was graded using the grading of recommendations, assessment, development, and evaluation approach. Overall, seven trials (eight articles) were included in this systematic review. Compared with usual care, inhaled corticosteroids was associated with significantly improved clinical recovery at 7 and 14 days in patients with COVID-19. In subgroup analysis, only budesonide showed significant efficacy in clinical recovery, whereas no significant benefit was observed for ciclesonide. Moreover, inhaled corticosteroids use was not significantly associated with all-cause hospitalization, all-cause mortality, admission to intensive care unit, or the use of mechanical ventilation. Our systematic review used evidence with very low to moderate certainty. Although based on limited evidence, our results suggest that inhaled corticosteroids treatment, especially budesonide, improves the clinical recovery of patients with COVID-19. More trials and meta-analyses are needed to assess the efficacy of inhaled corticosteroids for COVID-19 treatment.
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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