Budesonide, a cheap asthma drug, can alleviate covid-19 at home

AS VACCINATION against covid-19 gathers speed, the end of the covid-19 pandemic is starting to hover on the horizon. But not everyone will take the vaccine and none of the jabs is 100% effective at preventing any illness at all. Even where vaccination rates are high some people will, at some point, become infected. Results from a clinical trial in Britain published today show that budesonide, a cheap generic drug they can take at home, will make their illness slightly less miserable.

Budesonide is a corticosteroid drug widely used by people with asthma and chronic obstructive pulmonary disease, who take it using a palm-sized inhaler. Early in the pandemic doctors noticed that people with these conditions were under-represented among covid-19 patients. That looked odd, because they are particularly susceptible to other respiratory infections such as the flu. Laboratory studies found that in Petri dishes budesonide inhibits replication of SARS-CoV-2, the virus that causes covid-19. Like steroids in general, the drug also has an anti-inflammatory effect. All these things suggested that it was worth trying in patients with covid-19.

The results came from a trial called PRINCIPLE, which is testing treatments for covid-19 that people can take at home. The trial is run at more than 2,600 general-practice surgeries in Britain and is one of the biggest in the world for covid-19 outpatient treatments. It enrolled patients with covid-19 symptoms who were at high risk of becoming severely ill—people over 50 with various underlying health problems and people over 65 regardless of their general health. About 750 people were randomly selected and prescribed an easy-to-use inhaler with budesonide that they could take at home. They were compared with just over 1,000 patients who received usual care (which involves not much else than advice to take paracetamol and to keep an eye on blood-oxygen levels). On average, people in the trial had been unwell for six days before they were enrolled.

Researchers followed up the patients for 28 days. In the usual-care group the median time to recovery was 14 days. The misery was three days shorter for those who were prescribed budesonide; when asked daily, they also reported feeling less ill. By day 28, 10.3% of those who did not receive the drug were admitted to hospital. After adjusting for various differences between the two groups, the researchers found that the rate of admission in the budesonide group was 2.1 percentage points lower, though this result was preliminary and not statistically significant. If confirmed in the final analysis expected in the coming weeks, this result would mean that the drug can prevent the hospitalisation of one in five people who would otherwise have ended up in a covid-19 ward.

Budesonide is a cheap generic drug widely available around the world. It is “virtually side-effect free”, says Chris Butler of Oxford University, one of the lead researchers in the PRINCIPLE trial. An inhaler with the drug costs Britain’s National Health service only £14 ($19). All of this makes it an easy thing to prescribe to people who are nursing covid-19 at home. Primary-care doctors can finally offer them more than just sympathy.

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