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GPs told to no longer prescribe budesonide to treat Covid


budesonide recommendation


The chief medical officers (CMOs) have withdrawn a recommendation for GPs to prescribe inhaled budesonide as a treatment for Covid.

The commonly used asthma medication should now only be used in ‘the context of a clinical trial’ following updated advice from NICE, they said.

When budesonide was first recommended for GP use in April, NHS England said GPs would be expected to prescribe the drug to a ‘very limited’ number of Covid patients.

At the time, the Government said GPs could prescribe budesonide inhalers as a Covid treatment ‘on a case-by-case basis’ although it was not being ‘recommended for routine use’ at that ‘point in time’..

The recommendation followed ‘positive initial trial results’, the Government said at the time.

But a Central Alerting System (CAS) message last week said that ‘the previously published UK interim position statement covering inhaled budesonide as a treatment option for individuals with Covid infection has been withdrawn’.

It said this was ‘in parallel to the publication of revised guidance from [NICE]’.

The alert added: ‘Inhaled budesonide should no longer be considered as a treatment for Covid-19 infection other than within the context of a clinical trial.

‘People already using budesonide for conditions other than Covid-19 should continue treatment if they test positive for Covid-19.’

NICE updated its rapid guideline for Covid-19 this month following a panel review into the evidence regarding budesonide.

It said the panel found that ‘clinical evidence suggests there is no statistically significant difference for the outcomes of hospitalisation and death, or need for mechanical ventilation in people having inhaled budesonide and usual care compared with usual care alone’.

However, it did find that ‘inhaled budesonide statistically significantly reduces the need for oxygen administration compared with usual care’; and that patient-reported ‘time to sustained recovery was statistically significantly reduced with inhaled budesonide compared with usual care’.

On the whole, the panel concluded that budesonide had ‘a small net benefit, or little difference between alternatives’.

It was previously understood that NICE was reviewing evidence on the drug’s effectiveness from the Government’s PRINCIPLE trial, which first published interim results in April.

Meanwhile, results of a study published in The Lancet in August 2021 had confirmed some benefit of inhaled budesonide in Covid recovery in higher-risk patients in the community.

In April, NHS England asked the BMA to send guidance on budesonide to GPs on its behalf due to national mourning following Prince Phillip’s death.

As of this month, vulnerable patients in the community can access antivirals and monoclonal antibody treatments against Covid-19.

Click to complete relevant respiratory CPD modules on Pulse Learning.

Updated NICE guidance for budesonide to treat Covid-19

7.10 Budesonide (inhaled)

  • Only in research settings
  • Only use budesonide to treat COVID-19 as part of a clinical trial.

Remark: People already on budesonide for conditions other than Covid-19 should continue treatment if they test positive for Covid-19.

Source: NICE