Does inhaled corticosteroid speed up recovery from COVID-19 symptoms?

The use of inhaled ciclesonide provides no additional benefit to vaccinated adults exposed to Omicron variants of SARS-CoV-2 in fast-tracking their recovery from acute symptoms, a study has shown.

“Therefore, we do not recommend the use of inhaled corticosteroids in the current treatment of acute COVID-19,” the researchers said.

One hundred eighty-five patients were included in this two-arm, double-blind, placebo-controlled, community-based randomized trial. Participants received either inhaled ciclesonide 320 mcg daily or matching placebo for 14 days. Of these, 185 completed the treatment, and 96 percent were vaccinated against COVID-19.

The researchers also conducted an updated systematic review of all controlled trials of inhaled corticosteroids for acute COVID-19. Time to recovery of symptoms to day 28, the primary outcome, was assessed via proportional hazards analysis.

Time to first recovery did not significantly differ between the ciclesonide and placebo groups (recovery rate ratio, 1.04, 95 percent confidence interval [CI], 0.77‒1.40). The median time to recovery with ciclesonide was 7 days (95 percent CI, 6‒9), similar to that with placebo (median time to recovery, 7 days, 95 percent CI, 6‒9; p=0.84). [Respirology 2026;31:82-90]

“These trial results and updated combined evidence of placebo-controlled trials do not support the use of inhaled corticosteroids for the treatment of COVID-19,” the researchers said.

Other outcomes, including time to sustained recovery and respiratory symptoms, also did not significantly differ between the two groups. Furthermore, treatment was safe and well tolerated.

Risk of bias

“Our trial results did not show a benefit of inhaled steroids, but with wide CIs on the primary outcome of the rate of recovery from symptoms, a clinically important benefit is not excluded,” the researchers said.

“We therefore undertook an updated meta-analysis of all randomized controlled trials using inhaled corticosteroids, including our own results in accordance with the Lancet recommendation of putting trial results in context,” they added. [Lancet 2010;376:20-21]

Previous trials covered earlier variants of SARS-CoV-2 and populations largely naïve to infection and were also often open-labelled. These studies assessed symptom-based primary outcomes, with a seemingly high risk of bias due to unblinded therapy.

“These combined results showed evidence of heterogeneity of treatment effect when trials were grouped according to open-labelled versus placebo-controlled, and with no evidence of treatment benefit when restricted just to the placebo-controlled trials,” the researchers said.

Cough

Inhaled corticosteroids are usually prescribed to patients with acute respiratory illness, particularly those with symptoms such as cough. [npj Primary Care Respiratory Medicine 2014;24:14086]

However, an earlier systematic review of four randomized controlled trials found inconclusive evidence that inhaled corticosteroids reduced acute or persistent cough, although these medications were found to be safe. [Family Practice 2013;30:492-500]

“Cough was a frequent symptom that we also recorded, but even in those who rated it as moderate and severe, inhaled ciclesonide had no effect,” the researchers said. “We did not assess the risk of chronic cough.”