Inhaled asthma drug shortens Covid recovery and could be ‘significant for world,’ study finds

An inhaled drug commonly use for asthma has been shown to shorten the time it takes to recover from Covid-19 for ill patients who do not need hospital treatment – a development that has been described as a “significant milestone” in the fight against coronavirus.

British scientists from Oxford University have found that budesonide, an anti-inflammatory medicine, can help to accelerate recovery in people aged 50 and over by an average of three days.

The readily available drug, administered via a cheap inhaler twice a day for up to 14 days, can be prescribed through GPs, raising hope that doctors will be able to start treating Covid patients at home and during the early stages of their illness.

Work is now underway within the Department for Health and Social Care to start rolling out budesonide on a national scale through the NHS.

Experts have hailed the interim findings, which come from the UK’s Principle trial, as a major breakthrough in treating Covid-19 outside of hospital settings.

Oxford’s Professor Gail Hayward, a co-principal investigator in the trial, told a media briefing: “I think this does have significant implications for the world as this is the first time a treatment has been shown to be beneficial for patients in their community.

“The majority of patients who get Covid are in the community. Something that can help them feel better three days sooner is significant.”

For the Principle study, 751 people with symptomatic Covid-19 were treated with budesonide at home over a 14-day period. Their progress was compared with 1,028 patients who were assigned the usual standard of NHS care alone.

The two groups of patients were drawn from two groups vulnerable to severe Covid: those aged 65 and over, and people aged between 50 and 64 with comorbidities, including a weakened immune system, heart disease and lung disease.

Of those who received budesonide, the results showed the estimated median time to self-reported recovery was 3.011 days shorter than the control group.

Chris Butler, joint chief investigator of the trial and a primary care professor, said the drug “helps people at higher risk of worse outcomes from Covid-19 recover quicker, stay better once they feel recovered, and improves their wellbeing.”

Professor Richard Hobbs, joint chief investigator, said: “Unlike other proven treatments, budesonide is effective as a treatment at home and during the early stages of the illness. This is a significant milestone for this pandemic and a major achievement for community-based research.”

Some 32 per cent of those taking budesonide in the trial, compared to 22 per cent of the usual care group, recovered within the first 14 days of their treatment. They were followed up for a total of 28 days.

Scientists involved in the study have said they intend to continue assessing patients to determine whether budesonide also prevents the development of long Covid in those who have been infected with coronavirus.

There are also early indications that budesonide can prevent hospitalisation with Covid-19.

Among patients who had completed all 28 days of study follow-up, 8.5 per cent of those treated with the drug had been hospitalised as a result of their symptoms. This compares to 10.3 per cent of patients in the standard care group.

However, researchers say that since fewer people than expected were admitted to hospital in the trial, and with cases and admissions to hospital continuing to drop in the UK, the interim analysis – published as a pre-print – cannot prove whether budesonide reduces hospital admissions.

The trial was stopped on 31 March after researchers became confident that the drug was capable of improving recovery time. Their findings are drawn from data up to 25 March, meaning the results are not fully complete.

As soon as all remaining patients have completed their follow-up and a full analysis has been completed, detailed results on time to recovery and hospitalisations will be published.

Those treated with inhaled budesonide were asked to inhale 800 micrograms twice a day for 14 days and were followed up for 28 days. The researchers said not everyone in their study will have taken the medication for 14 days, as people tend to stop doing so when they feel better.

According to the data, 80 per cent of trial participants used budesonide for at least seven days.

Oxford’s Professor Mona Bafadhel, a consultant respiratory physician, said it was likely the medicine’s anti-inflammatory qualities helped to accelerate recovery from Covid-19. She said it was “possible” the drug also reduces viral replication.

Professor Stephen Powis, NHS England national medical director, said: “We are delighted to see these trial results for a medicine that could help people with Covid-19 recover more quickly at home instead of being admitted to hospital.

“While we await final trial results, GPs may wish to consider prescribing inhaled budesonide where there is a medical benefit to patients following a shared decision conversation.”

The Principle study is the world’s largest randomised trial of community-based treatments for Covid-19, led by Oxford University.

Researchers said they now intent to start assessing the impact of budesonide on Covid patients who are aged 18 and have comorbidities or shortness of breath.

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