Long-term corticosteroid therapy for patients with severe coronavirus disease 2019 (COVID-19)

  1. George Calcaianu
  2. Samuel Degoul
  3. Thibault Payen
  4. Bénédicte Michau
  5. Mihaela Calcaianu
  6. Bree Lawson
  7. Didier Bresson
  8. Didier Debieuvre
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Abstract

earlier and longer corticosteroid therapy with methylprednisolone could reduce the mortality and/or rate of ICU admission by 26% in patients with severe COVID-19, hospitalized in conventional medical ward.

Background

Low dose of dexamethasone reduced mortality in hospitalized COVID-19 patients who required respiratory support. Less is known about the efficacy of other corticosteroids in severe COVID-19 patients. This study was designed to determine if longer and earlier corticoid therapy in severe COVID-19 patients is associated with reduced mortality and/or reduced rate of ICU admission for worsening of respiratory state.

Methods

We performed a retrospective study with patients aged ≥ 18 years, with epidemiological and/or radiological suspected COVID-19, hospitalized in a regional hospital GHRMSA Mulhouse, France. Twenty-three patients received methylprednisolone (MP) as compassionate use, 1 mg/kg/day for seven days followed by prednisolone at a gradually reduced dosage, for 4 to 6 weeks. MP was started one week after COVID-19 symptoms first appeared. The primary composite outcome was mortality and/or ICU admission during hospitalisation.

Results

Between March 14th to June 5th 2020, 255 patients were screened, 181 were included, and 92 were analysed, 23 patients treated with MP and 69 received standard care. SARS-CoV2 infection was confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) in 82.3%. The overall composite outcome was higher in the control group: 42/69 patients (60.9%) versus 8/23 (34.8%) in the interventional group (p= 0.018). The correction of lymphopenia between days 1 to 7 was associated with better outcome (p=0.006).

Conclusion

These results suggest that earlier and longer corticosteroid therapy with methylprednisolone could reduce the mortality and/or rate of ICU admission in patients with severe COVID-19, hospitalized in conventional medical ward.

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