Ciclesonide inhaler for post-acute COVID-19 syndrome: promising clinical evidence

Background: Long-term COVID-19 symptoms are a serious health concern and impact medical resource utilization. Lung involvement in this pandemic due to the transmission trajectory elicits appropriate therapeutic management of pre-and post-viral infection. This aspect must cover both in terms of mitigation of disease by inhibiting the coronavirus RNA replication and in terms of repairing underlying tissues that are inflamed. This review article explores ciclesonide's treatment efficacy in patients with symptomatic COVID-19 infections supported by clinical findings. Methodology: A literature search was done using databases like PubMed and Science Direct to evaluate published works of literature from December 2019, when the outbreak of the new coronavirus was reported to date by using the following search terms; 'COVID -19 pneumonia, and corticosteroid', 'COVID-19 pneumonia and Ciclesonide', 'Coronavirus disease and corticosteroid/ciclesonide.' Both retrospective and randomized controlled trials (RCTs) highlighting the role of ciclesonide in COVID-19 pneumonia were eligible for inclusion. The search terms focused on studies conducted about local anti-inflammatory treatments and their use in managing long COVID-19 symptoms. Results: An inhaled ciclesonide is a standard drug that provides a local anti-inflammatory effect with the additional inhibition of viral proliferation recently indicated and researched for post-acute COVID-19 syndrome. Eight studies were included in the analysis. Among them, five studies have documented insufficient evidence to establish the clinical benefit of ciclesonide in COVID-19 in achieving the outcomes such as resolution/ alleviation of all COVID-19 symptoms, reduced hospitalization or mortality, exacerbation of pneumonia and reduction in duration of oxygen therapy. Three studies, however, have indicated that ciclesonide, alone or in combination, reduces hospital stays, lowers the risk of in-hospital mortality, reduces the length of COVID-19 viral shedding, and delays the progression to acute respiratory failure in patients with mild-to-severe COVID-19. Conclusion: Despite demographic limitations, early use of ciclesonide in COVID-19 patients has shown promising results in date research. However, a lack of studies with level-1 evidence is crucial to proving ciclesonide's efficacy and safety for long COVID-19 symptoms.