'Case-by-case' approach to GPs prescribing budesonide for COVID-19

Inhaled budesonide is not expected to be routinely prescribed for patients receiving treatment in the community for COVID-19 but can be considered 'case-by-case' by GPs, NHS officials have said.

An update issued through the NHS central alerting system on 12 April said that 'inhaled budesonide is not currently being recommended as standard of care but can be considered (off-label) on a case-by-case basis for symptomatic COVID-19 positive patients aged 65 and over, or aged 50 or over with co-morbidities'.

Advice issued from NHS leaders comes after a groundbreaking GP-led trial reported this week that the common corticosteroid could significantly reduce recovery time in patients with COVID-19 receiving treatment in the community.

Patients treated with the asthma drug were also less likely to require hospitalisation - although findings from the PRINCIPLE trial said numbers were too small to draw firm conclusions on whether budesonide could reduce risk of hospitalisation.

COVID-19 treatment

An interim position statement backed by UK health authorities says patients are eligible to be considered for treatment with inhaled budesonide if all of the following criteria are met:

  • Patients with onset of symptoms of COVID-19 within the past 14 days and symptoms are ongoing,
  • COVID-19 confirmed by PCR test within the past 14 days,
  • 65 years and over OR 50-64 years with a comorbidity consistent with a long-term health condition from the flu list.

The position statement also sets out advice on doses and products that can be prescribed - and highlights that advice on used of inhaled budesonide could be updated based on further results from the PRINCIPLE trial, as well as from further studies.

The therapeutic alert published by the NHS says prescribers should 'consider prescribing inhaled budesonide (off-label, on a case-by-case basis) for symptomatic COVID-19 positive patients in line with the published interim position statement using the usual routes, where supply allows'.

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