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*For medical professionals only
SARS-CoV-2 infection may be treated aggressively if unavoidable
.
With the emergence of the new crown (SARS-CoV-2) in 2019, the domestic new crown pneumonia epidemic prevention and control measures have changed
accordingly with the mutation of the virus.
From the initial "isolation" and "lockdown" to the current "short encounter", our distance from the new crown may have changed from a safe distance to a "zero distance"
.
Coupled with the fact that the SARS-CoV-2 variant Omicron is now more contagious, "impotence" may be inevitable
.
If we can't avoid SARS-CoV-2, we can reduce the risk
of coronavirus sequelae as much as possible.
While vaccination reduces the risk of hospitalization or severe illness and death from COVID-19 [1], studies have shown that this can only reduce the risk of partial death and acute sequelae[2].
This suggests that relying on vaccines as the only means of alleviating the sequelae of COVID may not be the most ideal option [2].
The study highlights that prevention of SARS-CoV-2 infection is as important as breakthrough infections, and the need to continue to focus on the prevention of SARS-CoV-2 breakthrough infections as a goal
of public health policy.
In the face of "impotence", how to reduce the risk of new crown pneumonia sequelae? STOIC research published in The Lancet Respiratory Medicine suggests that short-term inhaled corticosteroids, budesonide, may be an effective treatment for COVID-19 in early adulthood [3].
STOIC studies how it is designed, let's look
at it together.
"
One 2-stage, open-ended, parallel group,
Randomized controlled trials
The STOIC study was a phase 2, open-label, parallel-group, randomized controlled trial
conducted in a community in Oxfordshire, UK.
The recruitment criteria for the trial were that adults aged 18 years or older who developed symptoms of COVID-19 (new-onset cough, fever, or loss of smell, or both) within seven days would be eligible for inclusion
.
Participants were excluded if they had recently (within 7 days) used inhaled or systemic corticosteroids, or if they were known to be allergic to or contraindicated to inhaled budesonide
.
A total of 167 participants were recruited and assessed for eligibility, of whom 21 did not meet the eligibility criteria and were excluded
.
In the end, 146 participants were randomized to usual care (n = 73) and budesonide (n = 73).
In the randomized group, each subject recorded daily symptoms
with a pulse oximeter and thermometer.
On days 0, 7 and 14, swab samples
collected from the nasopharynx were collected by nurses at the subject's home.
On day 28, all subjects were tested
for serum SARS-CoV-2 antibodies at the trial center.
Treatment of long-term new crown,
These data may provide the answer
Compared with the usual treatment group, the clinical recovery time of budesonide group was shortened by 1 day, the median was 7 days (95% CI 6-9) in the budesonide group, and 8 days (95% CI 7-11) in the usual treatment group, which was statistically significant (p=0.
007).
Not only was the proportion of days of fever in the first 14 days (2%) lower in the budesonide group than in the usual care group (8%), but the proportion of fever for at least 1 day was lower than in the usual care group, and fewer days required antipyretic drugs (27% vs 50%; p=0.
025）
。
The results of the STOIC study also showed that fewer participants experienced persistent symptoms at days 14 and 28 after treatment in the budesonide group compared with usual care (95% CI 0.
075 to 0.
334; p=0.
003) and fewer participants with sequelae; Moreover, the mean total score change of the budesonide group in the common cold questionnaire (CCQ) and influenza patient report outcome questionnaire (FLUPro) within 14 days was significantly better than that in the usual treatment group (CCQ: 95% CI-0.
21-0.
02, p=0.
016; FLUPro: 95% CI-0.
21-0.
00, p=0.
044).
Combined with STOIC study data, it can be seen that short-term inhaled glucocorticoids, budesonide, may be an effective treatment
for COVID-19 in early adulthood.
And with this approach, the researchers also found that clinical deterioration in 91 percent of patients could be relatively reduced, which represents the efficacy of budesonide that is equivalent to the use of COVID-19 vaccines, even better than any treatment
used in hospitalized COVID-19 patients and patients with severe COVID-19.
Although the STOIC study had certain limitations, such as: not obtaining daily nasopharyngeal swab samples or samples from the lower respiratory tract; The trial analysis used raw mediation concentration data rather than logarithmic-transformed mediation data, which may overestimate the standard deviation (SD); The study had a small
sample size.
However, fever is a poor prognostic marker for severe COVID-19, and budesonide significantly reduces this proportion, further supporting that it may be an effective treatment and giving sufficient confidence
in the findings.
summary
Since the COVID-19 pandemic, mortality and morbidity rates have been high across the globe[4].
Although some people have been vaccinated and infected with the Omicron variant are mainly asymptomatic and mild, most patients have a good prognosis, but a small number of patients will still have critical conditions, more common in the elderly, people with chronic underlying diseases, late pregnancy and perinatal women, and obese people [4].
In order to reduce the long-term damage and sequelae caused by SARS-CoV-2 to our bodies, we still need to do a good job of daily personal protection, such as wearing masks, washing hands frequently, reducing the gathering of people and other non-pharmacological interventions
.
People who do not have contraindications to vaccination should also be vaccinated
as much as possible.
In addition to preventing SARS-CoV-2 infection, it is also necessary to respond to active treatment after SARS-CoV-2 infection
.
Overall, budesonide may be an effective treatment for early COVID-19 and may also help prevent the sequelae of COVID, and can be applied to global health care systems [3,5].
References:
[1].
style="margin-right: 8px;margin-left: 8px;outline: 0px;max-width: 100%;line-height: 2em;box-sizing: border-box !important;overflow-wrap: break-word !important;">[2].
Al-Aly,Z.
,Bowe,B.
&Xie,Y.
Long COVID after breakthrough SARS-CoV-2 infection[J].
Nat Med,2022 Jul; 28(7):1461-1467.
[3].
Ramakrishnan S,Nicolau DV Jr,Langford B,Mahdi M,etc.
Inhaled budesonide in the treatment of early COVID-19(STOIC):a phase 2,open-label,randomised controlled trial[J].
Lancet Respir Med.
2021 Jul; 9(7):763-772.
[4].
General Office of the National Health Commission of the People's Republic of China, Office of the State Administration of Traditional Chinese Medicine of the People's Republic of China.
Diagnosis and treatment plan of novel coronavirus pneumonia (trial 9th edition)[J].
China Medicine.
2022Vol.
17 No.
4:(481-487).
[5].
JRB A，MMB C，etc.
Early Th2 inflammation in the upper respiratory mucosa as a predictor of severe COVID-19 and modulation by early treatment with inhaled corticosteroids:a mechanistic analysis[J].
Lancet Respir Med 2022 Jun; 10(6):545-556.
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* The medical community strives for the professionalism and reliability of its publications, but does not promise the accuracy of the content; Relevant parties are requested to check
separately when adopting or using it as a basis for decision-making.
