Inhaled steroids being investigated as a possible treatment for Covid-19
The inhaled corticosteroid budesonide is now being investigated as part of trial for COVID-19 treatments that can be taken at home.
It has been added to the University of Oxford’s PRINCIPLE trial into treatments that can help people aged over 50 recover more quickly and prevent the need for hospital admission.
More than 2,100 people across the UK have taken part in the study, supported by the National Institute for Health Research.
The PRINCIPLE trial is primarily evaluating whether treatment prescribed in the first 14 days of Covid-19 illness can speed up recovery and prevent the need for hospital admission.
It is for people aged over 50 with certain underlying health conditions, or anyone aged over 65. Those with coronavirus symptoms, or a positive test result, can easily join from home online, over the telephone or via their GP practice.
Inhaled budesonide is commonly prescribed as part of the long-term management of asthma and chronic obstructive pulmonary disease, with no serious side-effects associated with short-term use.
In some COVID-19 patients, the body mounts a significant immune response to fight the virus, causing high levels of inflammation that can damage human cells in the airways and lungs.
Inhaling budesonide into the airways targets anti-inflammatory treatment where it is needed most, and can potentially minimise any lung damage that might otherwise be caused by the virus.
SARS-CoV-2, the virus that causes Covid-19, binds to ACE2 (angiotensin-converting enzyme 2) receptors lining cells in the airways, gaining entry to human cells and replicating within. Laboratory studies suggest that inhaled corticosteroids reduce the number of ACE2 receptors in the airways, and so may block entry of the virus into human cells.
Trial lead Professor Chris Butler said “Budesonide is relatively inexpensive, safe and easy-to-administer drug for respiratory conditions that may have a role to play in treating COVID-19.
“It is only through enrolling volunteers on a randomised controlled trial like PRINCIPLE that we can assess whether there are clear benefits or harms associated with potential treatments like budesonide.
“We need many more volunteers to join the trial so we can get the answers we really need to keep people with Covid-19 out of hospital. Like vaccines and preventative measures, treatments have an important role to play in minimising the burden of this disease on society.”
Patients enrolled in the study will be randomly assigned to receive an inhaler in the post and the usual standard-of-care from their clinician. They will be asked to inhale two puffs twice a day for 14 days with each puff providing a 400 microgram dose of budesonide. They will be followed-up for 28 days and will be compared with participants who have been assigned to receive the usual standard-of-care only.
The other treatments currently being evaluated are doxycycline and azithromycin, commonly-prescribed antibiotics thought to have additional anti-inflammatory properties.
To join the study visit www.principletrial.org
