Inhaled and intranasal ciclesonide for the treatment of covid-19 in adult outpatients: CONTAIN phase II randomised controlled trial
Canadian RCT (n=203; median age 35 years) found inhaled ciclesonide (600 mcg twice daily) plus intranasal ciclesonide (200 mcg daily) did not improve symptom resolution at 7 days (40% v 35% placebo; absolute adjusted risk difference 5.5%; 95% CI −7.8% to 18.8%).
Source:
British Medical Journal
SPS commentary:
The authors note that two other RCTs of inhaled corticosteroids (STOIC and PRINCIPLE) have suggested a benefit for inhaled budesonide, but both of these lacked a placebo, with the potential for placebo effect and bias in healthcare seeking behaviour. The current study was placebo-controlled, but had a number of other limitations, including inability to recruit the intended sample size (so could have been underpowered to show a small benefit), and the inclusion of mainly younger, healthy patients, therefore a possible benefit in older, higher-risk people cannot be excluded. Vaccinated people were excluded and it remains to be determined whether inhaled corticosteroids can reduce symptoms in vaccinated populations, however it would be expected that any observed effect would be smaller than in unvaccinated people. The authors suggest future studies should enrich for patients reporting baseline shortness of breath and examine outcomes to day 14, given the prolonged time to symptom resolution has been observed.