Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Inhaled corticosteroids vs Standard care/Placebo

This comparison will not be updated. Last search date 14 Dec, 2022.

Studies included but not extracted/included in the analysis: Terada J, Drug Discov Ther, 2022

Outpatients

Forest plots
(last update: 2022-10-07)

Summary of findings
(last update: 2022-10-14)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Inhaled corticosteroids
Comparison: Standard care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	Outcome not yet measured or reported
Clinical improvement D60	Outcome not yet measured or reported
Hospitalisation or death	RR: 0.81 (0.58 - 1.13)	12 fewer per 1000 (from 26 fewer to 8 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
5 trials Naggie S, 2022; Duvignaud A, 2022; Ezer N, 2021; Clemency B, 2021; Yu LM 2021 4299 participants		Inhaled corticosteroids 50 per 1,000 (36 - 70)	Standard care/Placebo 62 per 1,000
WHO progression score (level 7 or above) D28	RR: 1.01 (0.57 - 1.80)	0 fewer per 1000 (from 5 fewer to 10 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
3 trials Naggie S, 2022; Duvignaud A, 20222; Yu LM, 2021 3684 participants		Inhaled corticosteroids 12 per 1,000 (7 - 22)	Standard care/Placebo 12 per 1,000
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 0.74 (0.31 - 1.74)	1 fewer per 1000 (from 4 fewer to 4 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
5 trials Naggie S, 2022; Duvignaud A, 2022; Ezer N, 2021; Clemency B, 2021; Yu LM, 2021 4299 participants		Inhaled corticosteroids 4 per 1,000 (2 - 10)	Standard care/Placebo 6 per 1,000
All-cause mortality D60	RR: ( - )	Zero events in both groups		Very low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious no events in both groups
1 trials Clemency B, 2021 400 participants		Inhaled corticosteroids 0 per 1,000 ( - )	Standard care/Placebo 0 per 1,000
Viral negative conversion D7	RR: 0.78 (0.38 - 1.63)	53 fewer per 1000 (from 149 fewer to 152 more)		Very low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Duvignaud A, 2022 107 participants		Inhaled corticosteroids 188 per 1,000 (91 - 392)	Standard care/Placebo 241 per 1,000
Adverse events	RR: 1.02 (0.75 - 1.37)	2 more per 1000 (from 19 fewer to 28 more)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, missing data, and outcome measurement Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
4 trials Naggie; Duvignaud A, 2022; Ezer N, 2021; Clemency B, 2021 2239 participants		Inhaled corticosteroids 78 per 1,000 (57 - 105)	Standard care/Placebo 77 per 1,000
Serious adverse events	RR: 0.97 (0.55 - 1.74)	1 fewer per 1000 (from 12 fewer to 20 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, missing data, and outcome measurement Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
4 trials Naggie S, 2022; Duvignaud A, 2022; Ezer N, 2021; Clemency B, 2021 2239 participants		Inhaled corticosteroids 26 per 1,000 (15 - 47)	Standard care/Placebo 27 per 1,000

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Hospitalized patients

Forest plots
(last update: 2022-10-07)

To access all information :

click here for Outpatients
click here for Hospitalized patients

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Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=1025

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Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
NCT04885530 ACTIV 6 Naggie S, medRxiv, 2022 Full text Commentary Commentary	Mixed	Fluticasone (inhaled)	Placebo	RCT	Outpatients with confirmed COVID-19 (mild) treated at 93 centers in the USA.	N=1407	Some concerns Details	Full description
NCT04356495, EudraCT 2020-001435-27 COVERAGE Duvignaud A, Clin Microbiol Infect, 2022 Full text Commentary	Public/non profit	Ciclesonide	Standard care	RCT	Outpatients with confirmed COVID-19 (symptomatic) treated by 14 centers in France	N=217	Some concerns Details	Full description
N/A Alsultan M, Interdiscip Perspect Infect Dis, 2021 Full text Commentary	Not reported/unclear	Colchicine Budesonide Colchicine	Standard care Standard care Budesonide	RCT	Patients with suspected or confirmed COVID-19 (moderate-severe) admitted to a single center in Syria.	N=49	N/A	Full description
NCT04435795 CONTAIN Ezer N, BMJ, 2021 Full text Commentary Commentary	Mixed	Ciclesonide	Placebo	RCT	Outpatients with confirmed COVID-19 (mild, symptomatic) treated by multiple centers in Canada	N=215	Some concerns Details	Full description
NCT04377711 Clemency B, JAMA Intern Med, 2021 Full text Full text Commentary	Private	Ciclesonide	Standard Care	RCT	Outpatients with confirmed COVID-19 (mild, symptomatic) treated by 10 centers in the USA.	N=400	Some concerns Details	Full description
NCT04330586 Song JY, J Clin Med, 2021 Full text Commentary	Mixed	Ciclesonide	Standard care	RCT	Patients with confirmed COVID-19 (mild-moderate) admitted to 6 centers in South Korea.	N=61	High Details	Full description
ISRCTN86534580; EudraCT 2020-001209-22 PRINCIPLE Yu LM, Lancet, 2021 Full text Full text Commentary Commentary Commentary	Public/non profit	Budesonide	Standard care	RCT	Outpatients with suspected or confirmed COVID-19 (symptomatic-mild) treated by multiple centers in the UK	N=1073	Some concerns Details	Full description
NCT04416399 STOIC Ramakrishnan S, Lancet Respir Med, 2021 Full text Commentary Commentary	Mixed	Budesonide	Standard care	RCT	Outpatients with suspected or confirmed COVID-19 (mild) treated by a single center in the UK	N=146	N/A	Full description