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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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Merk VM, Phan TS, Brunner T. Regulation of Tissue Immune Responses by Local Glucocorticoids at Epithelial Barriers and Their Impact on Interorgan Crosstalk. Front Immunol 2021; 12:672808. [PMID: 34012456 PMCID: PMC8127840 DOI: 10.3389/fimmu.2021.672808] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/21/2021] [Indexed: 12/11/2022] Open
Abstract
The anti-inflammatory role of extra-adrenal glucocorticoid (GC) synthesis at epithelial barriers is of increasing interest with regard to the search for alternatives to synthetic corticosteroids in the therapy of inflammatory disorders. Despite being very effective in many situations the use of synthetic corticosteroids is often controversial, as exemplified in the treatment of influenza patients and only recently in the current COVID-19 pandemic. Exploring the regulatory capacity of locally produced GCs in balancing immune responses in barrier tissues and in pathogenic disorders that lead to symptoms in multiple organs, could provide new perspectives for drug development. Intestine, skin and lung represent the first contact zones between potentially harmful pathogens or substances and the body, and are therefore important sites of immunoregulatory mechanisms. Here, we review the role of locally produced GCs in the regulation of type 2 immune responses, like asthma, atopic dermatitis and ulcerative colitis, as well as type 1 and type 3 infectious, inflammatory and autoimmune diseases, like influenza infection, psoriasis and Crohn’s disease. In particular, we focus on the role of locally produced GCs in the interorgan communication, referred to as gut-skin axis, gut-lung axis or lung-skin axis, all of which are interconnected in the pathogenic crosstalk atopic march.
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Affiliation(s)
- Verena M Merk
- Department of Biology, Chair of Biochemical Pharmacology, University of Konstanz, Konstanz, Germany
| | - Truong San Phan
- Department of Biology, Chair of Biochemical Pharmacology, University of Konstanz, Konstanz, Germany
| | - Thomas Brunner
- Department of Biology, Chair of Biochemical Pharmacology, University of Konstanz, Konstanz, Germany
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Erin EM, Zacharasiewicz AS, Nicholson GC, Tan AJ, Neighbour H, Engelstätter R, Hellwig M, Kon OM, Barnes PJ, Hansel TT. Rapid effect of inhaled ciclesonide in asthma: a randomized, placebo-controlled study. Chest 2008; 134:740-745. [PMID: 18403668 DOI: 10.1378/chest.07-2575] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Ciclesonide is a novel inhaled corticosteroid for the treatment of asthma, and it is important to measure the onset of effect of this therapy on airway hyperresponsiveness (AHR), exhaled nitric oxide (NO), and levels of eosinophils in induced sputum. METHODS In a randomized, double-blind, crossover study, 21 patients with mild asthma inhaled ciclesonide 320 microg (ex-actuator) qd, ciclesonide 640 microg (ex-actuator) bid, and placebo for 7 days. Exhaled NO and AHR to adenosine monophosphate (AMP), measured as the provocative concentration of AMP producing a 20% reduction in FEV1 (PC20FEV1), were assessed after inhalation on days 1, 3 and 7. Eosinophil levels in induced sputum were also measured. RESULTS Ciclesonide 320 microg qd and 640 microg bid produced significantly greater improvements in PC20FEV1 compared with placebo on day 1 (within 2.5 h), and on days 3 and 7 (all p < 0.0001). On day 3, both ciclesonide doses significantly reduced exhaled NO levels by - 17.7 parts per billion (p < 0.0001) and - 15.4 parts per billion (p < 0.003) vs placebo, respectively. Significant reductions were maintained during the study with both ciclesonide doses (p < 0.01). A nonsignificant trend towards a decrease in eosinophil cell numbers was observed after 7 days of ciclesonide treatment, especially in patients receiving the higher dose. CONCLUSIONS A single dose of ciclesonide decreased AHR to AMP and exhaled NO within 3 h, while FEV, improved at 3 days and 7 days.
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Affiliation(s)
- Edward M Erin
- National Heart and Lung Institute Clinical Studies Unit, Imperial College, London, UK
| | - Angela S Zacharasiewicz
- Department of Pediatric and Adolescent Medicine, Pulmonary and Infectious Diseases, Wilhelminenspital, Vienna, Austria
| | - Grant C Nicholson
- National Heart and Lung Institute Clinical Studies Unit, Imperial College, London, UK
| | - Andrew J Tan
- National Heart and Lung Institute Clinical Studies Unit, Imperial College, London, UK
| | - Helen Neighbour
- National Heart and Lung Institute Clinical Studies Unit, Imperial College, London, UK
| | | | | | | | - Peter J Barnes
- Department of Thoracic Medicine, Imperial College, London, UK
| | - Trevor T Hansel
- National Heart and Lung Institute Clinical Studies Unit, Imperial College, London, UK.
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