Effect of Inhaled Ciclesonide in Non–Critically Ill Hospitalized Patients With Coronavirus Disease 2019: A Multicenter Observational Study in Japan

Abstract

Background Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic. Although systemic steroids play an important role in treating patients with severe COVID-19, the role of inhaled corticosteroids in non–critically ill, hospitalized patients with COVID-19 remains unclear. Methods We analyzed findings in non–critically ill, hospitalized patients with COVID-19 who were >18 years old and were admitted to 64 Japanese hospitals between January and September 2020. We performed propensity score matching analysis to evaluate 28-day and in-hospital mortality rates with or without inhaled ciclesonide within 2 days of admission. Sensitivity analyses using inverse probability weighting analysis, and generalized estimating equation method were also performed. Results Eligible patients (n = 3638) were divided into ciclesonide (n = 290) and control (n = 3, 393) groups. The 1-to-4 propensity score matching analysis included 271 ciclesonide users and 1084 nonusers. There were no significant differences between the 2 groups for 28-day (3.3% vs 2.3%; risk difference, 1.0% [95% confidence interval, −1.2 to 3.3]) or in-hospital (4.8% vs 2.6%; risk difference, 2.2 [−.5 to 4.9]) mortality rates. The sensitivity analysis showed similar outcomes. Conclusions From this multicenter observational study in Japan, inhaled ciclesonide did not decrease 28-day or in-hospital mortality rates in non–critically ill, hospitalized patients with COVID-19. Future large, multinational, randomized trials are required to confirm our results.