Intranasal corticosteroids may be protective against severe COVID-19

People using intranasal corticosteroids (INCS) may have a slight protective advantage against hospitalization for COVID-19 over non-INCS users. Writing in the Journal of Allergy and Clinical Immunology (JACI), authors stated “our study demonstrates that INCS usage is associated with decreased COVID-19-related hospital admission, ICU admission, and mortality.” The study was conducted because sites of entry for SARS-CoV-2 are highly expressed in nasal epithelial cells, but little is known as to whether INCSs have an impact on COVID-19 related outcomes. SARS-CoV-2 is known to use ACE2 receptors as an entry way into epithelial cells of the respiratory tract, and the nose has high expression of these receptors. Read Primer on post-Acute COVID-19 Syndrome Studies have shown that in allergic airway inflammation, the inflammatory cell IL-13 modulates ACE2 and related gene expression in airway epithelial cells in people with asthma and atopy. Some studies suggest lower hospitalization rates among asthmatics and COPD patients and it is hypothesized that intranasal corticosteroids may decrease the number of ACE2 receptors. The goal of the study was to determine the association between baseline INCS use and COVID-19-related outcomes. It used data on 72,147 patients aged 18 years and older in the Cleveland Clinic COVID-19 Research Registry who had a positive test for SARS-CoV-2 between April 1, 2020, and March 31, 2021. Children, pregnant women, and patients with a body mass index (BMI) greater than 80 kg/m2 were excluded. Also excluded were patients who had received a prescription for INCS inhaled corticosteroids prior to 2018 to exclude bias related to remote INCS or inhaled corticosteroid therapy, the researchers wrote. Of the patients, a total of 12,608 (17.5%) were hospitalized; 2,935 (4.1%) required ICU admission and 1,880 (2.6%) died during hospitalization. Read Risk of death 133% higher with Delta than original, Canadian study finds A significant number of patients, 10,187 (14.1%) were using INCS before SARS-CoV-2 infection, while 61,960 did not used INCS. When compared to non-users, the study showed INCS users had a lower risk for hospitalization, ICU admissions, and in-hospital mortality. Patients who used intranasal corticosteroids prior to COVID-19 illness were 22% less likely to be hospitalized, 23% less likely to be admitted to the intensive care unit, and 24% less likely to die from COVID-19 during hospitalization compared to patients not on intranasal corticosteroids. “Our findings demonstrate the need for future studies including RCTs (randomized controlled trials) on INCS usage to corroborate our findings and determine whether INCS improves health care—related outcomes due to COVID-19,” the researchers said. Sources: 1. https://www.jaci-inpractice.org/article/S2213-2198(21)00906-5/fulltext 2. https://www.newswise.com/coronavirus/cleveland-clinic-study-suggests-steroid-nasal-sprays-may-help-improve-outcomes-in-severe-covid-19-disease

Intranasal corticosteroids may be protective against severe COVID-19

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