Corticosteroid treatment of severe acute respiratory syndrome in Hong Kong

Yam, Loretta Yin‐Chun; Lau, Arthur Chun‐Wing; Lai, F. Y. L.; Shung, E.; Chan, James C.; Wong, Vivian

doi:10.1016/j.jinf.2006.01.005

Cited by 82 publications

(49 citation statements)

References 28 publications

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“…Several other cohort studies report that steroid use was associated with detrimental outcome ( Auyeung et al., 2005 ; Leung et al., 2005 ; Ng et al., 2004 ; Wang et al., 2005 ; Xie et al., 2005 ; Yam et al., 2007 ). Two retrospective cohort studies report that steroid use was associated with a higher risk of ICU admission and mortality ( Auyeung et al., 2005 ; Yam et al., 2007 ).…”

Section: Resultsmentioning

confidence: 99%

Immunosuppressive Drugs and COVID-19: A Review

et al. 2020

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Background Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is currently unknown whether immunosuppressive drugs are advantageous or detrimental in patients with COVID-19. Immunosuppressive drugs could be harmful in the initial phase of COVID-19. In this phase, the host immune response is necessary to inhibit viral replication. However, immunosuppressive drugs might have a beneficial effect in the later, more severe phase of COVID-19. In this phase, an overshoot of the host immune response (the “cytokine storm”) can cause ARDS, multiorgan failure and mortality. Aim To summarize the available evidence on the effect of immunosuppressive drugs on infection with SARS-CoV-2. The effects of immunosuppressive drugs on similar pandemic coronaviruses may resemble the effects on SARS-CoV-2. Thus, we also included studies on the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) Methods The study protocol was registered in PROSPERO (registration number CRD42020181137). We included randomized controlled trials (RCTs), cohort studies with a control group and case-control studies concerning humans ≥ 18 years old. We also included in-vitro studies and animal studies with a control group. Results and Conclusion Sixty-nine studies were included. Interestingly, MPA inhibits SARS-CoV-2 replication in-vitro . Clinical studies are needed to confirm the inhibitory effect of MPA on SARS-CoV-2 replication in-vivo . There are indications that corticosteroids and IL-6 inhibitors, like tocilizumab, can reduce mortality and prevent mechanical ventilation in patients with COVID-19. However, observational studies have contradictory results and the risk of bias is high. Thus, these results have to be confirmed in high-quality clinical trials before these drugs can be implemented as standard care. Based on the positive results of CNIs, mTOR inhibitors and thiopurine analogues in in-vitro studies with SARS-CoV and MERS-CoV, it would be interesting to investigate their effects on SARS-CoV-2 replication.

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Section: Resultsmentioning

confidence: 99%

Immunosuppressive Drugs and COVID-19: A Review

et al. 2020

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“…Since COVID-19 was first reported in December 2019, it has attracted global attention owing to its similarity to SARS-CoV and MERS-CoV in causing fatal respiratory disease, and its potential for causing large-scale human infection and economic disruption. When considering patients with SARS and MERS, the use of corticosteroids therapy is still debated (20,21). Corticosteroids therapy was used in the treatment of severe SARS because early anecdotal experience supported it, and radiological findings, and histologic features of critically ill patients with SARS were similar to those of patients with ARDS (22,23).…”

Section: Discussionmentioning

confidence: 99%

Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature

et al. 2020

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“…[16] Available data on systemic glucocorticoid therapy among coronavirus-infected patients mainly comes from studies of patients with SARS and MERS, but whether glucocorticoid therapy is definitively beneficial in the clinical management of these two coronavirus infections is still being debated. [13,20,21] Glucocorticoid therapy was used in the treatment of severe SARS because early anecdotal experience supported it, and radiologic findings and histologic features of critically ill patients with SARS were similar to those of patients with acute respiratory distress syndrome (ARDS). [22][23][24][25] As early as March 2003, China first summarized its experience in the management of SARS, and suggested that high-dose glucocorticoids should be used if patients had fever persisting for more than 3 days, or radiologic findings were suggestive of persistent lung involvement or progressive deterioration.…”

Section: Discussionmentioning

confidence: 99%

“…[53] It has been noted that if lung injury has been effectively controlled, appropriate doses of glucocorticoids based on disease severity may be beneficial for better outcomes of SARS. [10,21] In our study, we will investigate whether the use of mid-dose and shortcourse adjunctive glucocorticoid therapy to treat severe COVID-19 is advantageous, safe, and effective.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of glucocorticoid therapy in patients with severe coronavirus disease 2019: protocol of a randomized controlled trial

Qin

Zhou

et al. 2020

Chinese Medical Journal

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Background: At the end of 2019, a novel coronavirus outbreak emerged in Wuhan, China, and its causative organism has been subsequently designated the 2019 novel coronavirus (2019-nCoV). The effectiveness of adjunctive glucocorticoid therapy in the management of 2019-nCoV-infected patients with severe lower respiratory tract infections is not clear, and warrants further investigation. Methods: The present study will be conducted as an open-labeled, randomized, controlled trial. We will enrol 48 subjects from Chongqing Public Health Medical Center. Each eligible subject will be assigned to an intervention group (methylprednisolone via intravenous injection at a dose of 1-2 mg/kg/day for 3 days) or a control group (no glucocorticoid use) randomly, at a 1:1 ratio. Subjects in both groups will be invited for 28 days of follow-up which will be scheduled at four consecutive visit points. We will use the clinical improvement rate as our primary endpoint. Secondary endpoints include the timing of clinical improvement after intervention, duration of mechanical ventilation, duration of hospitalization, overall incidence of adverse events, as well as rate of adverse events at each visit, and mortality at 2 and 4 weeks. Discussion: The present coronavirus outbreak is the third serious global coronavirus outbreak in the past two decades. Oral and parenteral glucocorticoids have been used in the management of severe respiratory symptoms in coronavirus-infected patients in the past. However, there remains no definitive evidence in the literature for or against the utilization of systemic glucocorticoids in seriously ill patients with coronavirus-related severe respiratory disease, or indeed in other types of severe respiratory disease. In this study, we hope to discover evidence either supporting or opposing the systemic therapeutic administration of glucocorticoids in patients with severe coronavirus disease 2019. Trial registration: ClinicalTrials.gov, ChiCTR2000029386, http://www.chictr.org.cn/showproj.aspx?proj=48777.

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Corticosteroid treatment of severe acute respiratory syndrome in Hong Kong

Abstract: We speculate that corticosteroid with higher in-vitro inflammatory potency administered at timing and dosages commensurate with disease severity may be conducive to better outcome from SARS as a consequence of more effective control of immunopathological lung damage.

Cited by 82 publications

References 28 publications

Immunosuppressive Drugs and COVID-19: A Review

Immunosuppressive Drugs and COVID-19: A Review

Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature

Effectiveness of glucocorticoid therapy in patients with severe coronavirus disease 2019: protocol of a randomized controlled trial

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