Effect of Corticosteroid Therapy on the Duration of SARS-CoV-2 Clearance in Patients with Mild COVID-19: A Retrospective Cohort Study

Abstract

Introduction: In December, 2019, an outbreak of the coronavirus disease 2019 (COVID-19), which was caused by a novel coronavirus, started in Wuhan, China. So far, there is limited clinical evidence on the effect of corticosteroid therapy for this disease. This study aims to investigate the association between corticosteroid therapy and the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) clearance among patients with mild COVID-19. Methods: Patients with mild COVID-19 were enrolled from two medical centers in China between January 13, 2020 and February 29, 2020. Baseline characteristics and durations of RNA clearance were compared between the corticosteroid and non-corticosteroid therapy groups. The independent effects of corticosteroid therapy on the duration of RNA clearance were estimated by generalized linear models. Results: Of 82 patients with a mild infection, 40 patients were male (48.8%), with a median age of 49 years (interquartile range, IQR 36-61). Among those patients, 36 patients (43.9%) received corticosteroid therapy. The adjusted multivariate models showed that the effects of corticosteroids were non-significant on the durations of onset to first RNA clearance [b 2.48, 95% CI (95% confidence interval)-0.42 to 5.38, P = 0.0926] and to persistent RNA clearance (b 1.54, 95% CI-1.41 to 4.48, P = 0.3016), and durations of therapy to first RNA clearance (b 2.16, 95% CI-0.56 to 4.89, P = 0.1184) and to persistent RNA clearance (b 1.22, 95% CI-1.52 to 3.95, P = 0.3787). Conclusions: Corticosteroid therapy in patients with mild COVID-19 was not associated with the duration of SARS-CoV-2 clearance, suggesting that the use of corticosteroids may not be Cheng Ding and Xuewen Feng contributed equally to this work.

Corticosteroids for COVID-19 Therapy: Potential Implications on Tuberculosis

“…Few studies indicated a weak correlation between CST and clinical improvement of COVID-19, particularly when the patients have milder or less severe symptoms and do not require intensive care unit (ICU) admission. A clinical study with a small number of subjects found no correlation between methylprednisone therapy and clinical outcome when the COVID-19 cases showed no respiratory distress [ 47 , 48 ]. Furthermore, no beneficial effect to intravenous administration of dexamethasone, hydrocortisone, or methylprednisolone was reported in multi-centric studies done in China, Brazil and Iran [ 49 , 50 , 51 ].…”

Corticosteroids for COVID-19: worth it or not?

“…Application of CSs in a different cohort of hospitalized COVID-19 patients revealed a heterogeneous result. Ding et al, found no correlation between viral clearance duration and CSs in hospitalized mild COVID-19 patients [ 42 ]. Similarly, a meta-analysis of wang et al observed delayed viral clearance in hospitalized COVID-19 patients after using CSs along with and no-effective improvement [ 43 ].…”

Antiviral Effect of Budesonide against SARS-CoV-2

“…Although studies have shown that corticosteroids reduce viral loads [ 13 , 14 , 15 ], others have suggested that corticosteroids do not affect [ 17 ] or even slow coronavirus clearance [ 18 , 19 , 20 ], which has raised some general concern about corticosteroid admission in COVID-19 patients. Nevertheless, some corticosteroids (e.g., dexamethasone) have been found to improve survival in hospitalized patients, especially in patients who require mechanical ventilation [ 21 , 22 ].…”