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Duvignaud A, Lhomme E, Onaisi R, Sitta R, Gelley A, Chastang J, Piroth L, Binquet C, Dupouy J, Makinson A, Lefèvre B, Naccache JM, Roussillon C, Landman R, Wallet C, Karcher S, Journot V, Nguyen D, Pistone T, Bouchet S, Lafon ME, Molimard M, Thiébaut R, de Lamballerie X, Joseph JP, Richert L, Saint-Lary O, Djabarouti S, Wittkop L, Anglaret X, Malvy D. Inhaled ciclesonide for outpatient treatment of COVID-19 in adults at risk of adverse outcomes: a randomised controlled trial (COVERAGE). Clin Microbiol Infect 2022; 28:1010-1016. [PMID: 35304280 PMCID: PMC8920965 DOI: 10.1016/j.cmi.2022.02.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/08/2022] [Accepted: 02/20/2022] [Indexed: 12/23/2022]
Abstract
Objectives To assess the efficacy of inhaled ciclesonide in reducing the risk of adverse outcomes in COVID-19 outpatients at risk of developing severe illness. Methods COVERAGE is an open-label, randomized controlled trial. Outpatients with documented COVID-19, risk factors for aggravation, symptoms for ≤7 days, and absence of criteria for hospitalization are randomly allocated to either a control arm or one of several experimental arms, including inhaled ciclesonide. The primary efficacy endpoint is COVID-19 worsening (hospitalization, oxygen therapy at home, or death) by Day 14. Other endpoints are adverse events, maximal follow-up score on the WHO Ordinal Scale for Clinical Improvement, sustained alleviation of symptoms, cure, and RT-PCR and blood parameter evolution at Day 7. The trial's Safety Monitoring Board reviewed the first interim analysis of the ciclesonide arm and recommended halting it for futility. The results of this analysis are reported here. Results The analysis involved 217 participants (control 107, ciclesonide 110), including 111 women and 106 men. Their median age was 63 years (interquartile range 59–68), and 157 of 217 (72.4%) had at least one comorbidity. The median time since first symptom was 4 days (interquartile range 3–5). During the 28-day follow-up, 2 participants died (control 2/107 [1.9%], ciclesonide 0), 4 received oxygen therapy at home and were not hospitalized (control 2/107 [1.9%], ciclesonide 2/110 [1.8%]), and 24 were hospitalized (control 10/107 [9.3%], ciclesonide 14/110 [12.7%]). In intent-to-treat analysis of observed data, 26 participants reached the composite primary endpoint by Day 14, including 12 of 106 (11.3%, 95% CI: 6.0%–18.9%) in the control arm and 14 of 106 (13.2%; 95% CI: 7.4–21.2%) in the ciclesonide arm. Secondary outcomes were similar for both arms. Discussion Our findings are consistent with the European Medicines Agency's COVID-19 task force statement that there is currently insufficient evidence that inhaled corticosteroids are beneficial for patients with COVID-19.
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Affiliation(s)
- Alexandre Duvignaud
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, CHU Bordeaux, Bordeaux, France; IRD 271, Bordeaux, France
| | - Edouard Lhomme
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France; Inria SISTM, Bordeaux, France; Department of Public Health, CHU Bordeaux, Bordeaux, France
| | - Racha Onaisi
- Department of General Practice, Bordeaux University, Bordeaux, France
| | - Rémi Sitta
- CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France; Department of Public Health, CHU Bordeaux, Bordeaux, France
| | - Ambre Gelley
- CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France
| | - Julie Chastang
- Département de Médecine Générale, Sorbonne Université, France; Inserm 1136 IPLESP, Sorbonne Université, Paris, France
| | - Lionel Piroth
- Département d'infectiologie, CHU de Dijon, Dijon, France; Module Épidémiologie Clinique, Université de Bourgogne, CIC Inserm 1432, Dijon, France
| | - Christine Binquet
- Module Épidémiologie Clinique, Université de Bourgogne, CIC Inserm 1432, Dijon, France
| | - Julie Dupouy
- Inserm 1295 CERPOP, Université Toulouse III Paul Sabatier, Toulouse, France; Département universitaire de médecine générale, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Alain Makinson
- Université. de Montpellier, Inserm 1175, CIC 1411, Montpellier, France; Département des Maladies Infectieuses, CHU de Montpellier, Montpellier, France
| | - Benjamin Lefèvre
- Service des Maladies Infectieuses et Tropicales, CHRU Nancy, Nancy, France; Université de Lorraine, APEMAC, Nancy, France
| | - Jean-Marc Naccache
- Service de Pneumologie-Allergologie-Oncologie Thoracique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Caroline Roussillon
- Clinical Research and Innovation Department, Safety and Vigilance Unit, CHU Bordeaux, Bordeaux, France
| | - Roland Landman
- Inserm 1137 IAME, Université Paris Diderot, IMEA, Paris, France; Service de Maladies Infectieuses et Tropicales, AP-HP, CHU Bichat-Claude Bernard, Paris, France
| | - Cédrick Wallet
- CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France
| | - Sophie Karcher
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - Valérie Journot
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - Duc Nguyen
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, CHU Bordeaux, Bordeaux, France; IRD 271, Bordeaux, France
| | - Thierry Pistone
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, CHU Bordeaux, Bordeaux, France; IRD 271, Bordeaux, France
| | | | | | - Mathieu Molimard
- Clinical Research and Innovation Department, Safety and Vigilance Unit, CHU Bordeaux, Bordeaux, France
| | - Rodolphe Thiébaut
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France; Inria SISTM, Bordeaux, France; Department of Public Health, CHU Bordeaux, Bordeaux, France
| | - Xavier de Lamballerie
- Unité des Virus Émergents, IRD 190, Inserm 1207, Université Aix-Marseille, Marseille Cedex 05, France
| | | | - Laura Richert
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France; Inria SISTM, Bordeaux, France; Department of Public Health, CHU Bordeaux, Bordeaux, France
| | - Olivier Saint-Lary
- Centre for Research in Epidemiology and Population Health, Inserm 1018, Université Paris-Saclay Villejuif, Villejuif Cedex, France; Faculty of Health Sciences Simone Veil, Department of Family Medicine, Univ. Versailles Saint-Quentin en Yvelines, Montigny Le Bretonneux, France
| | - Sarah Djabarouti
- Pharmacy, CHU Bordeaux, Bordeaux, France; Inserm 1034, Université de Bordeaux, Bordeaux, France
| | - Linda Wittkop
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France; Inria SISTM, Bordeaux, France; Department of Public Health, CHU Bordeaux, Bordeaux, France
| | - Xavier Anglaret
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; IRD 271, Bordeaux, France.
| | - Denis Malvy
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, CHU Bordeaux, Bordeaux, France; IRD 271, Bordeaux, France
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