Checkout: 1.http://m.koreabiomed.com/news/articleView.html?idxno=7807. ; 2.https://www.biorxiv.org/content/10.1101/2020.03.11.987016v1 ; 3.http://world.kbs.co.kr/service/news_view.htm?lang=e&Seq_Code=152234
Please take a look at this useful RG link.
Preprint The inhaled corticosteroid ciclesonide blocks coronavirus RN...
At this point investigational tests are being done for antiviral drug, against the infection of the new coronavirus (COVID-19). In the treatment of Covid-19 scientists used remdesivir, hydroxychloroquine, convalescent plasma, inhaled ciclesonide, Kaletra, probiotic bacteria in sea buckthorn berry. The US government confirmed the testing of potential coronavirus vaccine mRNA-1273.
I did NOT think that it is a good idea to treat COVID-19 patients with inahled glucocorticosteroids (GCS).
So far, I also do not think that the article that Arvind Singh is of any help.
The problem is that almost all COVID-19 patients who are in ICU die due to sepsis. Not the virus kills the people, but the bacterial superinfeciton. Therefore, considerations that this or that GCS would have some virustatic or even virucid effects in vitro are totally irrelevant. The problem is that the GCS down-regulate the immune response that is of particuar importance when the virus has already destroyed some cells. And obivously, the SARS-CoV-2 virus does this.
Look at the Chinese data: Use of GCS was always a strong risk factor for unpleasant outcomes, and in particular for deaths.
Look at WHO or US CDC guideline which clearly WARN against GCS in COVID-19. And the respective German guideline repeats this,, but adds that only low dose hydrocortison (cortisol) could be considered in case of septic shock without response to fluid or vasopressor therapy. Look at the review of Russell et al, Lancet, February 2020!
For the time being (!) it appears that iGCS (in particular budesonide) already given for treatment of asthma are not associated with an increased risk. However, this assumption (or hope) is based on data from influenza epidemics, not from the current corona pandemic.
" similar antiviral ability to remdesivir, or the anti-HIV drug Kaletra. "
That is the difference between nonclinical and clinical trials.
There was an RCT published in the NEJM on Kaletra against COVID-19: Dispappointing.
There were several nonrandomised clinical studies and one accidentally published abstract (in fact by WHO!) on an RCT with remdesivir: Between not encouraging to disappointing.
I am not an expert, but there is an in vitro result at pg.17
Preprint Identification of antiviral drug candidates against SARS-CoV...
Maybe the in vitro data are encouraging. But, please acknowlegde this:
Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020 Feb 15;395(10223):473-475. doi: 10.1016/S0140-6736(20)30317-2.
Kalil AC. Treating COVID-19—Off-Label Drug Use, Compassionate Use, and Randomized Clinical Trials During Pandemics. JAMA Published March 24, 2020.
The hypothetic beneftis of inhaling GCS in an off-label indication, i.e. when sufferring from COVID-19, must be weighed against these statements which suggest harm by these drugs. Please also note that all Chinese data indicated close correlations between prescription of GCS and untoward outcomes.
Corticosteroids as double-edged sword for COVID-19 patients
Although corticosteroids suppress lung inflammation, they also inhibit immune responses and pathogen clearance including COVID-19.
They are, therefore, only used as adjuvent treatment in patients with COVID-19 induced cytokine storm with drugs like IL-6 inhibitors e.g Tocilizumab and supportive treatment. Its use alone is not recommended for COVID-19 pneumonia.
Please also see the link below.
https://jvi.asm.org/content/95/1/e01648-20