Asthma sprays with cortisone: No effect on Corona

2023-10-10 19:34:00

A current US study with around 1,400 test subjects, carried out according to the strictest scientific criteria, has finally put an end to false hopes: fluticasone, which is often used for inflammatory lung diseases, has no positive effect. “The effectiveness of inhaled glucocorticoids (ed.) in reducing the time to resolution of symptoms or preventing hospital admissions or deaths in outpatient Covid-19 patients with mild to moderate disease is unclear,” wrote David Boulware recently from the University of Minnesota and his co-authors in the “New England Journal of Medicine” (DOI: 10.1056/NEJMoa2209421).

Conflicting results

During the Covid-19 pandemic, many already known drugs were examined for possible effectiveness in SARS-CoV-2 infections. This led to contradictory results with the most effective anti-inflammatory drugs, various cortisone preparations. Two “open” studies with the active ingredient budesonide that were not controlled with placebo groups (no blinding as to who received what, note) showed evidence of faster recovery and clear trends towards fewer hospital admissions and deaths. However, three studies with random selection of test subjects, two of which were double-blind (covert use of active ingredient or placebo for all participants) with the cortisone ciclesonide, however, would have shown no effect.

No recommendation for cortisone

“The contradictory results led both the drug authorities and the authors of guidelines not to recommend inhaled cortisone for treatment in the early phase of Covid-19,” said the world’s most respected medical journal. Nevertheless, in the first phases of the pandemic there was temporary hype surrounding cortisone asthma sprays. They were often hoarded too. There were bottlenecks in the care of asthma sufferers. Austria, for example, imposed an export ban on inhaled cortisone preparations.

However, as part of the treatment of seriously ill Covid-19 patients in hospitals and intensive care units during the pandemic, it soon became clear that anti-inflammatory treatment with cortisone also had a certain positive effect. The new study now provides the answer to the question of a possible effect of inhaled cortisone sprays: a total of 1,407 test subjects were included in 91 centers in the USA. They all had a SARS-CoV-2 infection confirmed by PCR and at least two typical symptoms of the disease. 715 of the test subjects received a real fluticasone spray, which they were supposed to use once a day for 14 days, while 692 sufferers received a placebo spray. The selection was random; no one knew who really “took” what.

Criticism from the start

The data from 656 patients who had used the real asthma spray and from 621 people from the placebo group were evaluated. The results clearly speak against the effectiveness of cortisone. The scientists: “There was no indication that fluticasone led to a faster recovery (at least three days without symptoms; note). 24 participants in the fluticasone group (3.7 percent) went to an emergency room or were hospitalized, while 13 Subjects from the placebo group (2.1 percent).” Three patients were in the hospital for a longer period of time and there were no deaths.

The first assumptions that spoke of a possible benefit of cortisone (budesonide) for inhalation were viewed very critically by Austrian experts right from the start. “So there is not a single clear indication that the treatment has achieved anything and that it reduces moderate or severe disease,” said pulmonologist Marco Idzko from MedUni Vienna (AKH) at the end of April 2021, for example. The US study is quite meaningful for the current situation: it was already carried out in times of Covid-19 vaccination and the newer SARS-CoV-2 variants Delta and Omicron.