Thread by @SanjayResp

STOIC trial now published @LancetRespirMed. So excited to share the findings of our trial of inhaled budesonide for early #COVID19 A (long) thread 🧵
thelancet.com/journals/lanre…

We looked at 800 mcg of inhaled budesonide twice a day within 7 days of COVID19 symptom onset.
Primary outcome was requirement for urgent medical care. We also looked at temperature and oxygen saturation at home.

We recruited everyone over the age 18, not already taking inhaled or tablet steroids. Mean age 45. So a group not otherwise considered at risk.
We recruited participants at home. Huge thanks to @ChrisMwasuku, @KrassowskaK Bev and Helen, our superstar nurses who drove everywhere

Participants had a median 3 days of symptoms prior to joining study. Most had no co morbidities.
Participants randomised to BUD required 7 days of treatment on average (they were told to stop taking it when better).

STOIC showed that this early treatment reduced the need for urgent medical attention by 91% (relative risk). Number needed to treat to benefit was 8.
We think this is a very important finding for global health 🌍 Over 2 billion people will not have access to a vaccine in 2021

We also found a shorter time to (self reported) symptom recovery. Participants taking BUD recovered 1 day quicker than if they didn't.

Participants taking BUD also had a lower mean body temperature and quicker resolution of fever. We know fever is a major risk for severe #COVID19 and #LongCovid

We didn't know about #LongCovid when we started the study. But participants allocated budesonide had a lower chance of symptom persistence at day 14

This was also reflected in our symptom questionnaires. The benefit was particularly noticeable in the 'systemic' subsection of the symptoms. This covers joint pains and fatigue, important symptoms predicting #LongCovid

To summarise, inhaled budesonide, started within 7 days:
-Reduce risk of needing urgent medical attention for COVID19
-Reduce fever quicker
-Quickens symptom resolution
-Reduces chance of symptom persistence

Huge thank you to our Oxfordshire participants. They were so generous with their time. Thank you also to our funders @OxfordBRC and @AstraZeneca. We also got lots of help from @DHSCgovuk. @Investec also donated some PPE when we couldn't find any.

Special thank you to @RhysPainton our star trial manager with @OxfordRespTrial

A massive thank you to all the co-authors, working so hard to get this out so quickly. Dan Nicolau, Mahdi, @jrbaker88 @LouiseDResp @pippa_matt @jodiegiffo @russell_doc Jenny, Andreas. Our stats legends Stefan and Thomas. Our star GP recruiters (Drs Fox, Bright, Glover, Binnian)

Finally, super grateful for @MonaBafadhel, our chief investigator, who taught me how to run this amazing trial, kept us all motivated and got the job done! (Captain America just for you boss)

Sorry @NabilFadai. My rookie twitter error for not including you. Couldn’t have done it without your help. #TooExcited

So happy to see STOIC findings replicated so elegantly in the @TrialPrinciple. Exciting development for early treatment in #COVID19