Ciclesonide inhaler for post-acute COVID-19 syndrome: promisingclinical evidence
Main Article Content
Keywords
ciclesonide, anti-inflammatory, inhaled corticosteroid, COVID-19
Abstract
Background. Long-term COVID-19 symptoms are a serious health concern and impact medical resource utilization. Lung involvement in this pandemic due to the transmission trajectory elicits appropriate therapeutic management of pre-and post-viral infection. This aspect must cover both in terms of mitigation of disease by inhibiting the coronavirus RNA replication and in terms of repairing underlying tissues that are inflamed. This review article explores ciclesonide's treatment efficacy in patients with symptomatic COVID-19 infections supported by clinical findings.Methodology. A literature search was done using databases like PubMed and Science Direct to evaluate published works of literature from December 2019, when the outbreak of the new coronavirus was reported to date by using the following search terms; 'COVID -19 pneumonia, and corticosteroid', 'COVID-19 pneumonia and Ciclesonide','Coronavirus disease and corticosteroid/ciclesonide.' Both retrospective and randomized controlled trials (RCTs) highlighting the role of ciclesonide in COVID-19 pneumonia were eligible for inclusion. The search terms focused on studies conducted about local anti-inflammatory treatments and their use in managing long COVID-19 symptoms.Results. An inhaled ciclesonide is a standard drug that provides a local anti-inflammatory effect with the additional inhibition of viral proliferation recently indicated and researched for post-acute COVID-19 syndrome. Eight studies were included in the analysis. Among them, five studies have documented insufficient evidence to establish the clinical benefit of ciclesonide in COVID-19 in achieving the outcomes such as resolution/ alleviation of all COVID-19 symptoms, reduced hospitalization or mortality, exacerbation of pneumonia and reduction in duration of oxygen therapy. Three studies, however, have indicated that ciclesonide, alone or in combination, reduces hospital stays, lowers the risk of in-hospital mortality, reduces the length of COVID-19 viral shedding, and delays the progression to acute respiratory failure in patients with mild-to-severe COVID-19.Conclusion. Despite demographic limitations, early use of ciclesonide in COVID-19 patients has shown promising results in date research. However, a lack of studies with level-1 evidence is crucial to proving ciclesonide's efficacy and safety for long COVID-19 symptoms.
References
2. Chippa V, Aleem A, Anjum F. Post Acute Coronavirus (COVID-19) Syndrome. [Updated 2021 Jul 18]. In: StatPearls [Internet].Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570608/
3. Chopra V, Flanders SA, O’Malley M, et al. Sixty-Day Outcomes Among Patients Hospitalized With COVID-19. Ann InternMed. 2021;174(4):576-8. https://doi.org/10.7326/m20-5661
4. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreakin China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA.2020;323(13):1239-42. https://doi.org/10.1001/jama.2020.2648
5. Greenhalgh T, Knight M, A’Court C, et al. Management of post-acute COVID-19 in primary care. BMJ. 2020 ;370:3026. https://doi.org/10.1136/bmj.m3026
6. Montani D, Savale L, Beurnier A et al. Multidisciplinary approach for post-acute COVID-19 syndrome: time to break down the walls. Eur Respir J. 2021;58(1):2101090. https://doi.org/10.1183/13993003.01090-2021
7. Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603-5. https://doi.org/10.1001/jama.2020.12603
8. Al-Jahdhami I, Al-Naamani K, Al-Mawali A. The Post-acute COVID-19 Syndrome (Long COVID). Oman Med J. 2021;36(1):e220.https://doi.org/10.5001/omj.2021.91
9. Iwabuchi K, Yoshie K, Kurakami Y et al. Therapeutic potential of ciclesonide inhalation for COVID-19 pneumonia: Report of three cases. J Infect Chemother. 2020;26(6):625-2. https://doi.org/10.1016/j.jiac.2020.04.007
10. Mehta PP, Dhapte-Pawar VS. Novel and Evolving Therapies for COVID-19 Related Pulmonary Complications. Am J Med Sci. 2021;361(5):557-66. https://doi.org/10.1016/j.amjms.2021.02.019
11. Chugh H, Awasthi A, Agarwal Y, et al. A comprehensive review on potential therapeutics interventions for COVID-19. Eur JPharmacol. 2021;890:173741. https://doi.org/10.1016/j.ejphar.2020.173741
12. Ezer N, Belga S, Daneman N et al. Inhaled and intranasal ciclesonide for the treatment of COVID-19 in adult outpatients:CONTAIN phase II randomised controlled trial. BMJ. 2021;375:e068060. https://doi.org/10.1136/bmj-2021-068060
13. Clemency BM, Varughese R, Gonzalez-Rojas Y, et al. Efficacy of Inhaled Ciclesonide for Outpatient Treatment of Adolescents and Adults With Symptomatic COVID-19: A Randomized Clinical Trial. JAMA Intern Med. 2022;182(1):42-9. https://doi.org/10.1001/jamainternmed.2021.6759
14. Song JY, Yoon JG, Seo YB, et al. Ciclesonide Inhaler Treatment for Mild-to-Moderate COVID-19: A Randomized, Open-Label,Phase 2 Trial. J Clin Med. 2021;10(16):3545. https://doi.org/10.3390/jcm10163545
15. Duvignaud A, Lhomme E, Onaisi R, et al. Inhaled ciclesonide for outpatient treatment of COVID-19 in adults at risk of adverse outcomes: a randomised controlled trial (COVERAGE). Clin Microbiol Infect. 2022;28(7):1010-16. https://doi.org/10.1016/j.cmi.2022.02.031
16. Kuo KC, Chen CH, Wang CJ, et al. Clinical benefits of inhaled ciclesonide for hospitalized patients with COVID-19 infection: a retrospective study. BMC Pulm Med. 2022;22(1):368. https://doi.org/10.1186/s12890-022-02168-8
17. Terada-Hirashima J, Suzuki M, et al. Impact of inhaled ciclesonide on asymptomatic or mild COVID-19: A randomized trial. Drug Discov Ther. 2022;16(5):225-232. https://doi.org/10.5582/ddt.2022.01068
18. Terada J, Fujita R, Kawahara T et al. Favipiravir, camostat, and ciclesonide combination therapy in patients with moderate COVID-19 pneumonia with/without oxygen therapy: An open-label, single-center phase 3 randomized clinical trial.eClinicalMedicine. 2022;49:101484. https://doi.org/10.1016/j.eclinm.2022.101484
19. Brodin D, Tornhammar P, Ueda P et al. Inhaled ciclesonide in adults hospitalised with COVID-19: a randomised controlled open-label trial (HALT COVID-19). BMJ Open. 2023;13(2):e064374. https://doi.org/10.1136/bmjopen-2022-064374
20. Tagliati M, Leopoulou M, LeQuang J, et al. Ciclesonide Use in COVID-19: Not All Steroids Are the Same. Pharmacology & Pharmacy. 2021;12: 10-24.
21. Stein SW, Thiel CG. The History of Therapeutic Aerosols: A Chronological Review. J Aerosol Med Pulm Drug Deliv. 2017;30(1):20-41. https://doi.org/10.1089/jamp.2016.1297
22. Ogawa F, Kato H, Nakajima K, et al. Therapeutic strategy for severe COVID-19 pneumonia from clinical experience. European Journal of Inflammation. 2020. https://doi.org/10.1177/2058739220961591
23. COVIS PHARMA GROUP Announces Top-line Safety and Efficacy Data from a Phase 3 Placebo-Controlled COVID-19 Study Using Inhaled Corticosteroid (ciclesonide). https://www.globenewswire.com/news-release/2021/04/15/2210630/11011/en/COVIS-PHARMA-GROUP-Announces-Top-line-Safety-and-Efficacy-Data-from-a-Phase-3-Placebo-Controlled-COVID-19-Study-
Using-Inhaled-Corticosteroid-ciclesonide.html [accessed on 12 April 2023].