17.3.21 Budesonide in Early Covid Infection: implementation of the results of the STOIC study
Budesonide has not been approved by NICE for the treatment of COVID-19 infection and treatment of this condition is not included in its licence. If the therapy is used then this would be prescribed off-licence.
The STOIC study demonstrated that in patients given inhaled Budesonide (BUD) there was a significant reduction in the need to unscheduled medical care, a shorter period of symptoms and fever and more patients fully recovered (had no symptoms) at the 28 days. There were no significant side effects of the treatment.
Which drug, dose and preparation?
Budesonide is given in a dose of 800mcg bd through the Turbohaler device for 14 days.
Who should be treated?
The STOIC study recruited any patients with symptoms of COVID infection over the age of 18.
When should they be treated?
The STOIC study aimed to start participants on BUD within 7 days. The data suggests that the biggest benefit is seen when the BUD is started as soon as possible after the onset of symptoms ideally within 72 hours.
What benefits may be seen?
The STOIC data has shown that fever, flu-like symptoms all resolve earlier if treated with BUD. More of the patients also felt fully better at one month.
Are there any side effects?
BUD is an inhaled steroid and so there is a small chance of a patient developing a some mouth soreness and rarely this therapy may cause some oral thrush. The short duration of the treatment makes side effects unusual.
Can everyone receive this therapy?
This therapy is a common treatment given for asthma world-wide and there are no particular contraindications to this treatment other than pre-existing allergy or reaction to BUD.
What if they cannot use a Turbohaler?
It is unknown if the other inhaled steroids do have any efficacy against COVID-19. Although the mechanism of action of all steroids is similar and there is no reason why another inhaled steroid will not therefore have an effect. If another steroid is given because of an inability to use a Turbohaler correctly then an equivalent dose should be given as that of the BUD.