In 2020, Matsuyama et al. reported on in vitro studies on the capacity of various steroids to inhibit SARS CoV2 replication
https://jvi.asm.org/content/jvi/95/1/e01648-20.full.pdf
They tested an impressive of steroids and found that mometasone, algestone and ciclesonide to be equally effective, while budesonide lagged behind with about 50% of the efficacy of the three aforementionned substances. SPEZZANI V et al., in their case report on immunosuppression and COVID-19 https://smw.ch/article/doi/smw.2020.20246
specifically mentionned Matsuyama's observation
The recent publication of a study by RAMAKRISHNAN S et al. on the use of budesonide https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00160-0/fulltext has created a hype for the use of this substance in COVID-19.
It is interesting in this context to learn that both budesonide and ciclesonide have originally been manufactured by ASTRA ZENECA but in recent moves, a divestment has taken place. Are there objective pharmacological reasons for the preference of budesonide over ciclesonide in the prevention of severe COVID-19 or are the reasons for the choice of budesonide of purely commercial and marketing character?
I think budenoside works well, thus have potent anti-inflammatory actions that reduces inflammation and hyper-reactivity (spasm) of the airways
to Sileesh Mullasseri: thanks for your comment. Budesonide may work well but I am covinced that by comparing the efficacy of ciclesonide and budenoside in one and the same study would have improved the chance for the choice of the best compound for reducing both inflammation AND replication of coronavirus. During my last years of clinical activity I prescribed both drugs, but the fact that the active compound of ciclesonide is not set free in the pharynx but only after arrival in the small airway was considered as an advantage over budesonide through a reduced risk of pharyngeal candidiasis.