Ciclesonide

Last review completed on
September 30th, 2020

Ciclesonide is an inhaled corticosteroid used in the management of asthma. Ciclesonide is hypothesized to be helpful in the inflammation associated with SARS-CoV-2 infection, and it also may possess antiviral activity against SARS-CoV-2 in vitro. There are case reports suggesting that ciclesonide may inhibit proliferation of the virus and prevent progression to severe pneumonia when administered in the early or middle stages of infection.

Recommendation

There is insufficient evidence to support use of Ciclesonide for treatment of patients infected with SARS-CoV-2.

Level of Evidence
= Supporting use article = Neutral Article  = Contradicting use article

Step 1 - In vitro SARS CoV-1/2 and MERS-CoV
 Step 2 - In vivo MERS-CoV Step 3 - In vivo SARS CoV-2

Peer-reviewed Studies

Level 4: Observational SARS CoV-2 articles listed below Observational SARS CoV-2

  1. Supporting Use article Iwabuchi K., Yoshie K., Kurakami Y., Takahashi K., Kato Y., Morishima T. Therapeutic potential of ciclesonide inhalation for COVID-19 pneumonia: report of three cases. J Infect Chemother. 2020.
  2. Contradicting Use article Baba H, Kanamori H, Oshima K, Seike I, Niitsuma-Sugaya I, Takei K, Sato Y, Tokuda K, Aoyagi T. Prolonged presence of SARS-CoV-2 in a COVID-19 case with rheumatoid arthritis taking iguratimod treated with ciclesonide. J Infect Chemother. 2020 Oct;26(10):1100-1103.
  3. Supporting Use article Nakajima K, Ogawa F, Sakai K, Uchiyama M, Oyama Y, Kato H, Takeuchi I. A Case of Coronavirus Disease 2019 Treated With Ciclesonide. Mayo Clin Proc. 2020 Jun;95(6):1296-1297.

Level 1: In vitro SARS CoV-1/2 and MERS-CoV articles listed below In Vitro SARS CoV-1/2

  1. Supporting Use article Matsuyama S., Kawase M., Nao N., et al. The inhaled corticosteroid ciclesonide blocks coronavirus RNA replication by targeting viral NSP15. bioRxiv. 2020.
  2. Supporting Use article Kimura H, Kurusu H, Sada M, Kurai D, Murakami K, Kamitani W, Tomita H, Katayama K, Ryo A. Molecular pharmacology of ciclesonide against SARS-CoV-2. J Allergy Clin Immunol. 2020 Aug;146(2):330-331
  3. Supporting Use article Jeon S., Ko M., Lee J., et al. Identification of antiviral drug candidates against SARS-CoV-2 from FDA-approved drugs. bioRxiv. 2020.
  4. Supporting Use article Ko M., Chang S.Y., Byun S.Y., et al. Screening of FDA-approved drugs using a MERS-CoV clinical isolate from South Korea identifies potential therapeutic options for COVID-19. bioRxiv. 2020.
Immunomodulators