NHSE: GPs expected to treat ‘very limited’ number of Covid patients with budesonide

Only a ‘very limited’ number of patients are expected to be eligible for GP treatment with asthma drug budesonide, NHS England has said.

Modelling suggests fewer than one patient per practice per week will be eligible, but NHS England will monitor Covid prevalence rates to ensure general practice does not become ‘overwhelmed’, GPs were told in a webinar last night.

Last week, the Government said that GPs can prescribe budesonide inhalers as a Covid treatment ‘on a case-by-case basis’ although it is not ‘at this point in time’ being ‘recommended for routine use’, following positive initial trial results.

In a GP webinar last night, NHS England reiterated that eligible patients include those who have tested positive for Covid with a PCR test, whose symptoms began within the last 14 days, and are either aged 65 or over or 50 or over with underlying comorbidities. 

GPs should consider offering inhaled budesonide to these patients, making a shared decision with them on whether to prescribe it off-label, it added.

However, NHS England stressed that only small numbers of patients are expected to be eligible, with just 1,800 patients estimated to be eligible across England this week.

Slides presented at the webinar said: ‘Modelling shows that the number eligible is very limited, with fewer than one patient per practice per week and even fewer for community pharmacies. 

‘If demand were to grow due to any possible increases in infection rates, we will continue to monitor and keep the situation under review to ensure primary care does not face overwhelming pressures.’

NHS England deputy medical director of primary care Dr Kiren Collison added that Covid prevalence rates will be monitored, but that NHS England does not expect practices to be ‘overwhelmed’.

She said: ‘There obviously could be pockets of higher rates in some areas compared to others and we are keen to hear if anyone is becoming overwhelmed for any reason – please do let us know. But with the current prevalence rates, we wouldn’t expect that to happen.’

The slides added that while ‘no additional reporting is currently required’, NHS England and the Department of Health and Social Care (DHSC) are ‘working to put in place regular monitoring of data on prescriptions issued and dispensed’.

Monitoring of ‘general supply levels’ is also planned, but there are ‘no concerns’ about supply as ‘plans are in place’ to ensure there is enough for both patients who use the medicine normally and for any additional Covid patients, NHS England said.

Last week, initial findings from the PRINCIPLE trial reported a three-day median benefit in self-reported recovery for patients with Covid in the community setting who received inhaled budesonide.

The impact on hospitalisation rates and mortality has not yet been established and will be reported as part of the trial’s final findings.

It comes as the Government has launched a bid to identify antiviral drugs that patients can take at home when they have been diagnosed with, or exposed to, Covid – with an aim to roll out a treatment as early as the autumn.

Meanwhile, NHS England last week asked the BMA to send budesonide guidance to GPs on its behalf due to the period of national mourning following the death of Prince Phillip.