More data needed on impact of intranasal corticosteroids on COVID-19 outcomes

Key takeaways:

• Exposure to intranasal corticosteroids was not linked to COVID-19 mortality.
• Risk for all-cause mortality declined among patients with/without asthma/COPD using intranasal corticosteroids.

Intranasal corticosteroids did not impact COVID-19 mortality in patients with asthma, COPD or neither, but they did reduce the risk for all-cause mortality, according to study results published in Annals of Allergy, Asthma & Immunology.

“Our knowledge regarding the role of intranasal corticosteroids in COVID-19 is still limited, although it seems it could have a potential protective effect,” Virginia Hernandez Santiago, PhD, clinical lecturer in general practice at the University of St. Andrews’s School of Medicine, and colleagues wrote. “There is controversy in the role of corticosteroid therapy for infectious diseases as, on one hand they have been found beneficial for downregulating the exaggerated pro-inflammatory response, including improved outcomes in patients with severe COVID-19, but on the other they have been widely avoided for active infection because of their known immunosuppressive effects and concern about long-term complications, with greater mortality in sepsis when treated with high-dose corticosteroid therapy.”

In a retrospective cohort study, Santiago and colleagues evaluated data of 812,847 individuals from the general population of Scotland, including 42,994 patients who had COPD and 72,237 patients who had asthma.

Of these individuals, 50,326 used intranasal corticosteroids (INCS), including 5,376 patients with COPD and 10,212 patients with asthma. Also, 10,252 individuals were taking inhaled corticosteroids concomitantly.

Researchers compared these groups to understand the influence INCS have on COVID-19 mortality and all-cause mortality using Cox regression models that accounted for age, sex, deprivation, number of exacerbations in the past year and comorbidities.

In total, researchers reported 12,794 all-cause deaths and 1,028 COVID-19 deaths.

Although researchers did not observe a significant link between COVID-19 mortality and INCS taken by those with COPD (HR = 0.6; 95% CI, 0.3-1.1), asthma (HR = 0.9; 95% CI, 0.2-3.9) or in the general population (HR = 0.8; 95% CI, 0.6-1), researchers did observe significant relationships between INCS and all-cause mortality.

Specifically, patients with asthma taking INCS demonstrated the greatest decline in all-cause mortality by 50% (HR = 0.5; 95% CI, 0.3-0.7), followed by individuals in the general population with a 40% decreased risk (HR = 0.6; 95% CI, 0.5-0.6) and patients with COPD with a 30% decreased risk (HR = 0.7; 95% CI, 0.6-0.8).

When evaluating the dual use of INCS and ICS, researchers found a 60% (HR = 0.4; 95% CI, 0.3-0.5) reduced risk for all-cause death in the cohort with asthma, a 47% (HR = 0.53; 95% CI, 0.5-0.6) reduced risk in the general population and a 50% (HR = 0.5; 95% CI, 0.4-0.6) reduced risk in the cohort with COPD.

“Further studies are needed to explore the association between INCS use and inflammatory activation, viral load, ACE2 gene expression, and outcomes, including studies exploring different types of intranasal steroids, and different dosage regimens,” Santiago and colleagues wrote.