Intranasal Corticosteroids are Associated with Better Outcomes in Coronavirus Disease 2019 (COVID-19)

Strauss, Ronald; Jawhari, Nesreen; Attaway, Amy H.; Hu, Bo; Jehi, Lara; Milinovich, Alex; Ortega, Victor E.; Zein, Joe G.

Background Sites of entry for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are highly expressed in nasal epithelial cells, however little is known about the impact of intranasal corticosteroids (INCS) on Coronavirus Disease 2019 (COVID-19) related outcomes. Objective Determine the association between baseline INCS use and COVID-19 related outcomes. Methods Using the Cleveland Clinic COVID-19 Research Registry (CCCRR), we performed a propensity score matching for treatment with INCS prior to SARS-CoV-2 infection (April 1, 2020 - March 31, 2021). Of the 82,096 individuals who tested positive, 72,147 met inclusion criteria. Our endpoints included need for hospitalization, admission to the intensive care unit (ICU), or in-hospital mortality. Results Of the 12,608 (17.5%) who were hospitalized, 2,935 (4.1%) required ICU admission and 1,880 (2.6%) died during hospitalization. A significant proportion (n=10,187; 14.1%) were utilizing INCS prior to SARS-CoV-2 infection. Compared to non-users, INCS users demonstrated lower risk for hospitalization (adjusted OR [95% CI]: 0.78 [0.72; 0.85]), ICU admission (adjusted OR [95% CI]: 0.77 [0.65; 0.92]) and in-hospital mortality (adjusted OR [95% CI]: 0.76 [0.61; 0.94]). These findings were replicated in sensitivity analyses where patients on inhaled corticosteroids, and those with allergic rhinitis were excluded. The beneficial effect of INCS was significant after adjustment for baseline blood eosinophil count (measured prior to SARS-CoV-2 testing) in a subset of 30,289 individuals. Conclusion INCS therapy is associated with a lower risk for COVID-19-related hospitalization, ICU admission, or death. Future randomized control trials are needed to determine if INCS reduces the risk for severe outcomes related to COVID-19.