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Randomized Controlled Trial
. 2023 Feb 22;13(2):e064374.
doi: 10.1136/bmjopen-2022-064374.

Inhaled ciclesonide in adults hospitalised with COVID-19: a randomised controlled open-label trial (HALT COVID-19)

Daniel Brodin #  1 , Per Tornhammar #  2 , Peter Ueda #  3 , Anders Krifors  4   5 , Eli Westerlund  6 , Simon Athlin  7 , Sandra Wojt  8 , Olof Elvstam  9 , Anca Neumann  1 , Arsim Elshani  10 , Julia Giesecke  2 , Jens Edvardsson-Källkvist  11 , Sayam Bunpuckdee  2 , Christian Unge  8 , Martin Larsson  12   13 , Björn Johansson  14 , Johan Ljungberg  14 , Jonas Lindell  15 , Johan Hansson  16 , Ola Blennow #  17   18 , Daniel Peter Andersson #  19
Affiliations
Randomized Controlled Trial

Inhaled ciclesonide in adults hospitalised with COVID-19: a randomised controlled open-label trial (HALT COVID-19)

Daniel Brodin et al. BMJ Open. .

Abstract

Objective: To assess the efficacy of inhaled ciclesonide in reducing the duration of oxygen therapy (an indicator of time to clinical improvement) among adults hospitalised with COVID-19.

Design: Multicentre, randomised, controlled, open-label trial.

Setting: 9 hospitals (3 academic hospitals and 6 non-academic hospitals) in Sweden between 1 June 2020 and 17 May 2021.

Participants: Adults hospitalised with COVID-19 and receiving oxygen therapy.

Intervention: Inhaled ciclesonide 320 µg two times a day for 14 days versus standard care.

Main outcome measures: Primary outcome was duration of oxygen therapy, an indicator of time to clinical improvement. Key secondary outcome was a composite of invasive mechanical ventilation/death.

Results: Data from 98 participants were analysed (48 receiving ciclesonide and 50 receiving standard care; median (IQR) age, 59.5 (49-67) years; 67 (68%) men). Median (IQR) duration of oxygen therapy was 5.5 (3-9) days in the ciclesonide group and 4 (2-7) days in the standard care group (HR for termination of oxygen therapy 0.73 (95% CI 0.47 to 1.11), with the upper 95% CI being compatible with a 10% relative reduction in oxygen therapy duration, corresponding to a <1 day absolute reduction in a post-hoc calculation). Three participants in each group died/received invasive mechanical ventilation (HR 0.90 (95% CI 0.15 to 5.32)). The trial was discontinued early due to slow enrolment.

Conclusions: In patients hospitalised with COVID-19 receiving oxygen therapy, this trial ruled out, with 0.95 confidence, a treatment effect of ciclesonide corresponding to more than a 1 day reduction in duration of oxygen therapy. Ciclesonide is unlikely to improve this outcome meaningfully.

Trial registration number: NCT04381364.

Keywords: COVID-19; clinical trials; respiratory infections.

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Conflict of interest statement

Competing interests: This study received non-financial support from COVIS Pharma (study drug donation). The authors have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram for study participants.
Figure 2
Figure 2
Time to termination of oxygen therapy during 30 days after randomisation.
See this image and copyright information in PMC

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