Common Nasal Spray Cuts COVID Risk by Two-Thirds in Clinical Trial - Video

A new clinical trial, published in JAMA Internal Medicine, has shown that azelastine nasal spray may significantly reduce the risk of SARS-CoV-2 infection. The phase 2 randomized, double-blind study, titled CONTAIN, involved 450 participants and revealed a threefold lower infection rate in the treatment group using azelastine compared to those given a placebo.

The trial divided participants into two groups. The treatment group, consisting of 227 individuals, used an azelastine nasal spray three times daily for 56 days. The 223 participants in the control group used a placebo spray over the same period. “During the observation period, 2.2% of the participants in the azelastine group became infected with SARS-CoV-2; in the placebo group, it was 6.7% — three times as many,” said Professor Robert Bals, Director of the Department of Internal Medicine V at Saarland University Medical Center and Professor of Internal Medicine at Saarland University. All infections were verified through PCR testing.

Beyond reducing SARS-CoV-2 infections, the azelastine group also showed fewer symptomatic COVID-19 cases, fewer overall respiratory infections, and—unexpectedly—a reduced incidence of rhinovirus infections. Only 1.8% of the treatment group developed a rhinovirus infection, compared to 6.3% in the placebo group, mirroring the findings seen with coronavirus cases.

Professor Bals sees practical implications for these findings: “Azelastine nasal spray could provide an additional easily accessible prophylactic to complement existing protective measures, especially for vulnerable groups, during periods of high infection rates, or before travelling.” However, he emphasized the need for further investigation: “Our results highlight the need for larger, multicentre trials to continue exploring the use of azelastine nasal sprays as an on-demand preventive treatment.”

Reference: Thorsten Lehr, Peter Meiser, Dominik Selzer, Torben Rixecker, Frank Holzer, Ralph Mösges, Sigrun Smola, Robert Bals, Veronika Alberg, Florian Bub, Nicholas Biwank, Charlotte Dette, Lale Dastgir, Alina Kuntz, Christopher Hale, Johanna Sophie Kapp, Kathrin Litzenburger, Henning Morr, Johanna Wagner, Hacer Sahin, Nelli Schröder, Martina Seibert, Katrin Thieser, Quirin Werthner. Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections. JAMA Internal Medicine, 2025; DOI: 10.1001/jamainternmed.2025.4283