Association between inhaled corticosteroid use and COVID ‐19 outcomes

  1. Anders Husby
  2. Anton Pottegård
  3. Anders Hviid

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Abstract

Background

Recent evidence has established a beneficial effect of systemic corticosteroids for treatment of moderate‐to‐severe COVID‐19.

Objective

To determine if inhaled corticosteroid use is associated with COVID‐19 outcomes.

Methods

In a nationwide cohort of hospitalized SARS‐CoV‐2 test‐positive individuals in Denmark, we estimated the 30‐day hazard ratio of intensive care unit (ICU) admission or death among users of inhaled corticosteroids (ICS) compared with users of bronchodilators (β 2 ‐agonist/muscarinic‐antagonists), and non‐users of ICS overall, with Cox regression adjusted for age, sex, and other confounders. We repeated these analyses among influenza test‐positive patients during 2010–2018.

Results

Among 6267 hospitalized SARS‐CoV‐2 patients, 614 (9.8%) were admitted to ICU and 677 (10.8%) died within 30 days. ICS use was associated with a hazard ratio of 1.09 (95% CI [CI], 0.67 to 1.79) for ICU admission and 0.78 (95% CI, 0.56 to 1.11) for death compared with bronchodilator use. Compared with no ICS use overall, the hazard ratio of ICU admission or death was 1.17 (95% CI, 0.87–1.59) and 1.02 (95% CI, 0.78–1.32), respectively. Among 10 279 hospitalized influenza patients, of which 951 (9.2%) were admitted to ICU and 1275 (12.4%) died, the hazard ratios were 1.43 (95% CI, 0.89–2.30) and 1.11 (95% CI, 0.85–1.46) for ICU admission, and 0.80 (95% CI, 0.63–1.01) and 1.03 (95% CI, 0.87–1.22) for death compared with bronchodilator use and no ICS use overall, respectively.

Conclusion

Our results do not support an effect of inhaled corticosteroid use on COVID‐19 outcomes, however we can only rule out moderate‐to‐large reduced or increased risks.

Study registration

The study was pre‐registered at encepp.eu (EUPAS35897).

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  1. Version published to 10.1002/pds.5345
  2. ScreenIT

    SciScore for 10.1101/2020.09.03.20187278: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.09.03.20187278v1 on medRxiv