Ciclesonide Inhaler Treatment for Mild-to-Moderate COVID-19: A Randomized, Open-Label, Phase 2 Trial
Although some intravenous drugs have been used to treat coronavirus disease 2019 (COVID-19), no effective antiviral agents are currently available in the outpatient setting. We aimed to evaluate the efficacy and adverse events of 14-day ciclesonide treatment vs. standard care for patients with mild-...
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creator | Song, Joon-Young Yoon, Jin-Gu Seo, Yu-Bin Lee, Jacob Eom, Joong-Sik Lee, Jin-Soo Choi, Won-Suk Lee, Eun-Young Choi, Young-Ah Hyun, Hak-Jun Seong, Hye Noh, Ji-Yun Cheong, Hee-Jin Kim, Woo-Joo |
description | Although some intravenous drugs have been used to treat coronavirus disease 2019 (COVID-19), no effective antiviral agents are currently available in the outpatient setting. We aimed to evaluate the efficacy and adverse events of 14-day ciclesonide treatment vs. standard care for patients with mild-to-moderate COVID-19. A randomized, open-label, multicenter clinical trial of ciclesonide inhalers was conducted in patients with mild-to-moderate COVID-19. Patients were enrolled within 3 days of diagnosis or within 7 days from symptom onset and randomly assigned to receive either ciclesonide (320 µg inhalation twice per day for 14 days) or standard care. The primary endpoint was the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) eradication rate on day 14 from study enrollment. Clinical status was assessed once daily, and serial nasopharyngeal viral load was evaluated by quantitative reverse transcription polymerase chain reaction. There were 35 and 26 patients in the ciclesonide and standard care groups, respectively. The SARS-CoV-2 eradication rate at day 14 was significantly higher in the ciclesonide group (p = 0.021). In multivariate analysis, SARS-CoV-2 negative conversion within 14 days was 12 times more likely in the ciclesonide group (95% confidence interval, 1.187–125.240). Additionally, the clinical failure rate (high-flow nasal oxygen therapy or mechanical ventilation) was significantly lower in the ciclesonide group (p = 0.034). In conclusion, ciclesonide inhalation shortened SARS-CoV-2 viral shedding duration, and it may inhibit the progression to acute respiratory failure in patients with mild-to-moderate COVID-19. Clinical Trial Registration NCT04330586. |
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We aimed to evaluate the efficacy and adverse events of 14-day ciclesonide treatment vs. standard care for patients with mild-to-moderate COVID-19. A randomized, open-label, multicenter clinical trial of ciclesonide inhalers was conducted in patients with mild-to-moderate COVID-19. Patients were enrolled within 3 days of diagnosis or within 7 days from symptom onset and randomly assigned to receive either ciclesonide (320 µg inhalation twice per day for 14 days) or standard care. The primary endpoint was the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) eradication rate on day 14 from study enrollment. Clinical status was assessed once daily, and serial nasopharyngeal viral load was evaluated by quantitative reverse transcription polymerase chain reaction. There were 35 and 26 patients in the ciclesonide and standard care groups, respectively. The SARS-CoV-2 eradication rate at day 14 was significantly higher in the ciclesonide group (p = 0.021). In multivariate analysis, SARS-CoV-2 negative conversion within 14 days was 12 times more likely in the ciclesonide group (95% confidence interval, 1.187–125.240). Additionally, the clinical failure rate (high-flow nasal oxygen therapy or mechanical ventilation) was significantly lower in the ciclesonide group (p = 0.034). In conclusion, ciclesonide inhalation shortened SARS-CoV-2 viral shedding duration, and it may inhibit the progression to acute respiratory failure in patients with mild-to-moderate COVID-19. Clinical Trial Registration NCT04330586.</description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm10163545</identifier><identifier>PMID: 34441840</identifier><language>eng</language><publisher>Basel: MDPI AG</publisher><subject>Asthma ; Clinical medicine ; Clinical trials ; Consent ; Coronaviruses ; COVID-19 ; Disease transmission ; Drugs ; Enrollments ; Hospitals ; Inhalers ; Oxygen saturation ; Pneumonia ; Public health ; Respiratory failure ; RNA polymerase ; Severe acute respiratory syndrome coronavirus 2</subject><ispartof>Journal of clinical medicine, 2021-08, Vol.10 (16), p.3545</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 by the authors. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c452t-af84845de85e9d935769e5d6e2e3962fffe230a294ae4a79d1328f9f0279f3c83</citedby><cites>FETCH-LOGICAL-c452t-af84845de85e9d935769e5d6e2e3962fffe230a294ae4a79d1328f9f0279f3c83</cites><orcidid>0000-0002-4546-3880 ; 0000-0002-0148-7194 ; 0000-0003-2635-6315 ; 0000-0001-5183-1996</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396813/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396813/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids></links><search><creatorcontrib>Song, Joon-Young</creatorcontrib><creatorcontrib>Yoon, Jin-Gu</creatorcontrib><creatorcontrib>Seo, Yu-Bin</creatorcontrib><creatorcontrib>Lee, Jacob</creatorcontrib><creatorcontrib>Eom, Joong-Sik</creatorcontrib><creatorcontrib>Lee, Jin-Soo</creatorcontrib><creatorcontrib>Choi, Won-Suk</creatorcontrib><creatorcontrib>Lee, Eun-Young</creatorcontrib><creatorcontrib>Choi, Young-Ah</creatorcontrib><creatorcontrib>Hyun, Hak-Jun</creatorcontrib><creatorcontrib>Seong, Hye</creatorcontrib><creatorcontrib>Noh, Ji-Yun</creatorcontrib><creatorcontrib>Cheong, Hee-Jin</creatorcontrib><creatorcontrib>Kim, Woo-Joo</creatorcontrib><title>Ciclesonide Inhaler Treatment for Mild-to-Moderate COVID-19: A Randomized, Open-Label, Phase 2 Trial</title><title>Journal of clinical medicine</title><description>Although some intravenous drugs have been used to treat coronavirus disease 2019 (COVID-19), no effective antiviral agents are currently available in the outpatient setting. We aimed to evaluate the efficacy and adverse events of 14-day ciclesonide treatment vs. standard care for patients with mild-to-moderate COVID-19. A randomized, open-label, multicenter clinical trial of ciclesonide inhalers was conducted in patients with mild-to-moderate COVID-19. Patients were enrolled within 3 days of diagnosis or within 7 days from symptom onset and randomly assigned to receive either ciclesonide (320 µg inhalation twice per day for 14 days) or standard care. The primary endpoint was the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) eradication rate on day 14 from study enrollment. Clinical status was assessed once daily, and serial nasopharyngeal viral load was evaluated by quantitative reverse transcription polymerase chain reaction. There were 35 and 26 patients in the ciclesonide and standard care groups, respectively. The SARS-CoV-2 eradication rate at day 14 was significantly higher in the ciclesonide group (p = 0.021). In multivariate analysis, SARS-CoV-2 negative conversion within 14 days was 12 times more likely in the ciclesonide group (95% confidence interval, 1.187–125.240). Additionally, the clinical failure rate (high-flow nasal oxygen therapy or mechanical ventilation) was significantly lower in the ciclesonide group (p = 0.034). In conclusion, ciclesonide inhalation shortened SARS-CoV-2 viral shedding duration, and it may inhibit the progression to acute respiratory failure in patients with mild-to-moderate COVID-19. Clinical Trial Registration NCT04330586.</description><subject>Asthma</subject><subject>Clinical medicine</subject><subject>Clinical trials</subject><subject>Consent</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Disease transmission</subject><subject>Drugs</subject><subject>Enrollments</subject><subject>Hospitals</subject><subject>Inhalers</subject><subject>Oxygen saturation</subject><subject>Pneumonia</subject><subject>Public health</subject><subject>Respiratory failure</subject><subject>RNA polymerase</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><issn>2077-0383</issn><issn>2077-0383</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkd9LHDEQx0NRqlif-g8EfBF02_zcTXwQ5Grbg5MTOfsacptJL0d2cyZ7hfrXu3JHsc7LDMyHD_NlEPpMyRfONfm6bjtKaM2lkB_QMSNNUxGu-MGb-QidlrImYyklGG0-oiMuhKBKkGPkJqGNUFIfHOBpv7IRMl5ksEMH_YB9yvguRFcNqbpLDrIdAE_mv6bfKqqv8A1-sL1LXXgGd4nnG-irmV1CvMT3K1sAs1EVbPyEDr2NBU73_QQ9fr9dTH5Ws_mP6eRmVrVCsqGyXgklpAMlQTvNZVNrkK4GBlzXzHsPjBPLtLAgbKMd5Ux57QlrtOet4ifoeufdbJcduHZMkG00mxw6m_-aZIP5f9OHlfmd_hg1-hXlo-B8L8jpaQtlMF0oLcRoe0jbYpisayKIVGxEz96h67TN_RjvlZJM1UzQkbrYUW1OpWTw_46hxLw-0Lx5IH8Bfi6KGQ</recordid><startdate>20210812</startdate><enddate>20210812</enddate><creator>Song, Joon-Young</creator><creator>Yoon, Jin-Gu</creator><creator>Seo, Yu-Bin</creator><creator>Lee, Jacob</creator><creator>Eom, Joong-Sik</creator><creator>Lee, Jin-Soo</creator><creator>Choi, Won-Suk</creator><creator>Lee, Eun-Young</creator><creator>Choi, Young-Ah</creator><creator>Hyun, Hak-Jun</creator><creator>Seong, Hye</creator><creator>Noh, Ji-Yun</creator><creator>Cheong, Hee-Jin</creator><creator>Kim, Woo-Joo</creator><general>MDPI AG</general><general>MDPI</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>COVID</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4546-3880</orcidid><orcidid>https://orcid.org/0000-0002-0148-7194</orcidid><orcidid>https://orcid.org/0000-0003-2635-6315</orcidid><orcidid>https://orcid.org/0000-0001-5183-1996</orcidid></search><sort><creationdate>20210812</creationdate><title>Ciclesonide Inhaler Treatment for Mild-to-Moderate COVID-19: A Randomized, Open-Label, Phase 2 Trial</title><author>Song, Joon-Young ; Yoon, Jin-Gu ; Seo, Yu-Bin ; Lee, Jacob ; Eom, Joong-Sik ; Lee, Jin-Soo ; Choi, Won-Suk ; Lee, Eun-Young ; Choi, Young-Ah ; Hyun, Hak-Jun ; Seong, Hye ; Noh, Ji-Yun ; Cheong, Hee-Jin ; Kim, Woo-Joo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c452t-af84845de85e9d935769e5d6e2e3962fffe230a294ae4a79d1328f9f0279f3c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Asthma</topic><topic>Clinical medicine</topic><topic>Clinical trials</topic><topic>Consent</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Disease transmission</topic><topic>Drugs</topic><topic>Enrollments</topic><topic>Hospitals</topic><topic>Inhalers</topic><topic>Oxygen saturation</topic><topic>Pneumonia</topic><topic>Public health</topic><topic>Respiratory failure</topic><topic>RNA polymerase</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Song, Joon-Young</creatorcontrib><creatorcontrib>Yoon, Jin-Gu</creatorcontrib><creatorcontrib>Seo, Yu-Bin</creatorcontrib><creatorcontrib>Lee, Jacob</creatorcontrib><creatorcontrib>Eom, Joong-Sik</creatorcontrib><creatorcontrib>Lee, Jin-Soo</creatorcontrib><creatorcontrib>Choi, Won-Suk</creatorcontrib><creatorcontrib>Lee, Eun-Young</creatorcontrib><creatorcontrib>Choi, Young-Ah</creatorcontrib><creatorcontrib>Hyun, Hak-Jun</creatorcontrib><creatorcontrib>Seong, Hye</creatorcontrib><creatorcontrib>Noh, Ji-Yun</creatorcontrib><creatorcontrib>Cheong, Hee-Jin</creatorcontrib><creatorcontrib>Kim, Woo-Joo</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of clinical medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Song, Joon-Young</au><au>Yoon, Jin-Gu</au><au>Seo, Yu-Bin</au><au>Lee, Jacob</au><au>Eom, Joong-Sik</au><au>Lee, Jin-Soo</au><au>Choi, Won-Suk</au><au>Lee, Eun-Young</au><au>Choi, Young-Ah</au><au>Hyun, Hak-Jun</au><au>Seong, Hye</au><au>Noh, Ji-Yun</au><au>Cheong, Hee-Jin</au><au>Kim, Woo-Joo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ciclesonide Inhaler Treatment for Mild-to-Moderate COVID-19: A Randomized, Open-Label, Phase 2 Trial</atitle><jtitle>Journal of clinical medicine</jtitle><date>2021-08-12</date><risdate>2021</risdate><volume>10</volume><issue>16</issue><spage>3545</spage><pages>3545-</pages><issn>2077-0383</issn><eissn>2077-0383</eissn><abstract>Although some intravenous drugs have been used to treat coronavirus disease 2019 (COVID-19), no effective antiviral agents are currently available in the outpatient setting. We aimed to evaluate the efficacy and adverse events of 14-day ciclesonide treatment vs. standard care for patients with mild-to-moderate COVID-19. A randomized, open-label, multicenter clinical trial of ciclesonide inhalers was conducted in patients with mild-to-moderate COVID-19. Patients were enrolled within 3 days of diagnosis or within 7 days from symptom onset and randomly assigned to receive either ciclesonide (320 µg inhalation twice per day for 14 days) or standard care. The primary endpoint was the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) eradication rate on day 14 from study enrollment. Clinical status was assessed once daily, and serial nasopharyngeal viral load was evaluated by quantitative reverse transcription polymerase chain reaction. There were 35 and 26 patients in the ciclesonide and standard care groups, respectively. The SARS-CoV-2 eradication rate at day 14 was significantly higher in the ciclesonide group (p = 0.021). In multivariate analysis, SARS-CoV-2 negative conversion within 14 days was 12 times more likely in the ciclesonide group (95% confidence interval, 1.187–125.240). Additionally, the clinical failure rate (high-flow nasal oxygen therapy or mechanical ventilation) was significantly lower in the ciclesonide group (p = 0.034). In conclusion, ciclesonide inhalation shortened SARS-CoV-2 viral shedding duration, and it may inhibit the progression to acute respiratory failure in patients with mild-to-moderate COVID-19. Clinical Trial Registration NCT04330586.</abstract><cop>Basel</cop><pub>MDPI AG</pub><pmid>34441840</pmid><doi>10.3390/jcm10163545</doi><orcidid>https://orcid.org/0000-0002-4546-3880</orcidid><orcidid>https://orcid.org/0000-0002-0148-7194</orcidid><orcidid>https://orcid.org/0000-0003-2635-6315</orcidid><orcidid>https://orcid.org/0000-0001-5183-1996</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Asthma Clinical medicine Clinical trials Consent Coronaviruses COVID-19 Disease transmission Drugs Enrollments Hospitals Inhalers Oxygen saturation Pneumonia Public health Respiratory failure RNA polymerase Severe acute respiratory syndrome coronavirus 2 |
title | Ciclesonide Inhaler Treatment for Mild-to-Moderate COVID-19: A Randomized, Open-Label, Phase 2 Trial |
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