Hidenori Dokai M.D. Ph.D, Hiroaki Inomata M.D.
Japanese doctors have reported that an asthma drug Alvesco(R), aerosol-type inhaled corticosteroids (ICS), appears to be effective in reducing symptoms of coronavirus patients who developed pneumonia[1], although their report is written in Japanese and not peer-reviewed.
The report shows that the three patients were given Alvesco, whose main component is ciclesonid, in the regular manner using dedicated inhaler for the forming ciclesonid itself into aerosol on February 20 and their health improved in about two days.
In general, particles of the aerosol could be reached in alveoli of lungs, where SARS-CoV-2 multiply and damage the surrounding tissues, when the mean diameter of particles in the aerosol is <2 micrometer[2]. This condition is thought to be satisfied in Alvesco[3].
Therefore, they speculate that ciclesonid in the state of aerosol reach the alveoli, suppress the virus multiplication and relieve the inflammation resulting in reducing symptoms of COVID-19 patients.
However, it is strange that no ICS drugs other than Alvesco are effective for COVID-19. According by the report[1], researchers in Japanese National Institute of Infectious Diseases (NIID https://www.niid.go.jp/niid/en/ ) had done many screening tests in vitro on other ICSs clinically available in Japan to confirm whether each of them suppress the virus multiplication resulting in vain except Alvesco. In addition ciclesonid itself seems to have no ability to suppress the virus multiplication though it have anti-inflammatory effect[4].
What is difference between Alvesco and other aerosol-type ICSs?
One of the clues to solve this problem might have been ethanol which is additive specific for Alvesco[5]. Assuming that ethanol destroyed the envelope of SARS-CoV-2 and ciclesonid suppressed inflammation induced by COVID-19, this assumption could be good explanation why only Alvesco among aerosol-type ICSs is effective for COVID-19.
Hidenori Dokai M.D. Ph.D
JPS Board Certified Pediatrician
Hiroaki Inomata M.D. B.A.
Psychiatrist
twitter
facebook
1) available at: http://www.kansensho.or.jp/uploads/files/topics/2019ncov/covid19_casereport_200302_02.pdf
2) Rohatagi S, Derendorf H, Zech K. Risk-Benefit Value of Inhaled Corticosteroids: A Pharmacokinetic/Pharmacodynamic Perspective. Chest. 2003;123:430S-431S.
3) Newman S, Salmon A, Nave R, Drollman A. High lung deposition of 99mTc-labeled ciclesonide administered via HFA-MDI to patients with asthma. Respiratory Medicine. 2006;100:375-384.
4) available at: https://www.alvesco.us/_resources/Alvesco_PI_2019.04.pdf
5) “Drug Delivery Systems” p553, Academic Press, Rakesh Tekade, ISBN: 9780128145081
