#304 Budesonide Bests COVID-19

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- Results statistically significant unless otherwise noted.
- Randomized controlled trial (RCT)1 of 1856 symptomatic COVID-19 positive patients aged ≥65, or ≥50 with co-morbidities. Randomized to budesonide 800ug inhaled BID x14 days or usual care.
- Mean age 64, ~80% had comorbidities (most common: hypertension and diabetes), symptom onset 6 days prior.
- First recovery day: ~12 days budesonide versus ~15 days usual care, difference ~3 days.
- Hospital admission or death: 6.8% budesonide versus 8.8%, difference 2%.
- Result not statistically different but analysis suggests 96% probability that benefit was real.
- Other outcomes improved with budesonide:
- Percent recovered by 14 days: 32% versus 22% [number needed to treat (NNT)=10], contact with health services: 54% versus 59% (NNT=18).
- Mean age 64, ~80% had comorbidities (most common: hypertension and diabetes), symptom onset 6 days prior.
- RCT2: Budesonide 800ug inhaled BID (for duration of symptoms, median 7 days) or usual care in 146 (generally, younger/lower risk) adults with COVID-19 symptoms (94% confirmed):
- Mean age 45, median one comorbidity/patient, symptom onset 3 days prior
- Urgent care or higher visit: 3% budesonide versus 15%, NNT=9.
- Symptoms present at 14 days: 10% budesonide versus 30%, NNT=5.
- Mean age 45, median one comorbidity/patient, symptom onset 3 days prior
- Limitations: Open label,1,2 no placebo arm,1,2 1% fully vaccinated,1 adverse effect poorly reported.1
- Systemic steroids reduce mortality in hospitalized patients with COVID-19.
- Greatest benefit in mechanically ventilated patients and no benefit in hospitalized not requiring oxygen.3
- Guidelines for management of COVID-19 outpatients variable: Inhaled budesonide not mentioned,4 not recommending for/against,5 or included as potential option.6
- Budesonide 400ug inhaler: ~$110 per unit.7