Effect of methylprednisolone in severe and critical COVID-19: Analysis of 102 cases

Zhu, Hongming; Li, Yan; Li, Bangyi; Yang, Shuang; Ding, Pingyu; Yang, Xiaojiao; Sun, Xuelian; Zhang, Mei

doi:10.12998/wjcc.v8.i23.5952

Cited by 14 publications

(12 citation statements)

References 36 publications

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“…There were 11 RCTs [ 11 – 14 , 23 – 26 ] (DEXA-COVID 19, NCT04325061; COVID STEROID, NCT04348305; Steroids-SARI, NCT04244591) and 44 OSs [ 21 , 22 , 27 – 68 ] that reported an association between mortality and corticosteroid therapy in patients with COVID-19. There were only one RCT [ 23 ] and eight OSs [ 33 , 34 , 46 , 49 , 55 – 58 ] that used pulse dose of corticosteroid.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

Cui

Sun

et al. 2021

Infect Dis Ther

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Introduction We conducted a comprehensive literature review to synthesize evidence for the relationship between corticosteroid use and mortality in patients with COVID-19. Methods The PUBMED, EMBASE, and Cochrane Library were searched from inception to March 13, 2021. We searched and analyzed randomized controlled trials (RCTs) and observational studies (OSs) that examined corticosteroid use in patients with COVID-19. The primary outcome was in-hospital mortality, while the secondary outcome was the need for mechanical ventilation (MV) and serious adverse events. Results A total of 11 RCTs and 44 OSs involving 7893 and 41,164 patients with COVID-19 were included in the study. Corticosteroid use was associated with lower COVID-19 mortality in RCTs, but was not statistically significant (OR 0.91, 95% CI 0.77–1.07; I 2 = 63.4%). The subgroup analysis of pulse dose corticosteroid showed survival benefit statistically (OR 0.29, 95% CI 0.15–0.56). Moreover, the corticosteroid use may reduce the need for MV (OR 0.67, 95% CI 0.51–0.90; I 2 = 7.5%) with no significant increase in serious adverse reactions (OR 0.84, 95% CI 0.30–2.37; I 2 = 33.3%). In addition, the included OSs showed that the pulse dose (OR 0.66, 95% CI 0.45–0.95; I 2 = 30.8%) might lower the mortality in patients with COVID-19. The pulse dose of methylprednisolone (OR 0.60, 95% CI 0.45–0.80; I 2 = 0%) had a beneficial effect on survival. It was especially significant when the duration of pulse methylprednisolone use was less than 7 days (OR 0.59, 95% CI 0.43–0.80; I 2 = 0%). Conclusions This meta-analysis indicated that corticosteroid use might cause a slight reduction in COVID-19 mortality. However, it could significantly reduce the MV requirement in patients with COVID-19 and restrict serious adverse events. Additionally, the pulse dose of methylprednisolone for less than 7 days may be a good treatment choice for patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00518-3.

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Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

Cui

Sun

et al. 2021

Infect Dis Ther

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“…Based on the abovementioned considerations, several immunomodulatory drugs have been used compassionately or in clinical trials early in the pandemic, hypothesizing that targeted interventions for immune dysregulation may change COVID-19 pneumonia outcomes. This has partially derived from previous experiences with acute respiratory distress syndrome, sepsis, and other “cytokine storm” diseases[ 13 , 14 ], representing a change of paradigm that has not been fully demonstrated to be safe and effective.…”

Section: Discussionmentioning

confidence: 99%

COVID-19: Considerations about immune suppression and biologicals at the time of SARS-CoV-2 pandemic

Costanzo¹,

Cordeddu²,

Chessa³

et al. 2021

WJCC

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The extent of the profound immunological and nonimmunological responses linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is currently being investigated worldwide due to the large burden associated with death due to SARS-CoV-2 and the short-term consequences of coronavirus disease 2019 (COVID-19). It has been hypothesized that patients on immunosuppressive treatments, including biologics, may have an augmented risk of being infected by SARS-CoV-2; however, there are currently no definitive data about biological drugs and COVID-19 in immune-mediated inflammatory diseases. Current epidemiological models developed to understand how long the COVID-19 epidemic may last are not conclusive and range from sustained epidemics to complete elimination. Nevertheless, even in the best-case scenario of apparent elimination, there is concordance about a possible contagion resurgence as late as 2024. Therefore, knowledge of the impact of SARS-CoV-2 on immune-mediated diseases and among patients treated with biologicals, together with the results of novel and promising COVID-19 treatment strategies targeting the virus and the host immune response (or both), will help us to best manage our patients during this pandemic over the next few years.

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“…There is no benefit in the use of glucocorticoids in terms of lung function or time to discharge 26 Yan Hu/China Single-center study 308 Steroids/No steroids 54 (44–63)/48 (39–60) 47.2%/46.7% COVID- 19 patients with pulmonary involvement None Equivalent of methylprednisolone 0.75–1.5 mg/kg/d) Glucocorticoid therapy did not significantly influence the clinical course, adverse events nor the outcome of COVID-19 pneumonia 27 Muhammad A. Rana/PAK Retrospective quasi-experimental study 60 Dexamethasone/Methylprednisolone 53.8/53.9 66.7%/70% Patients treated in HDU/ICU and had been on bi-level positive airway pressure. Not mentioned Dexamethasone 8 mg BID/Methylprednisolone 40 mg BID; 8 days Dexamethasone is more effective in improving the P/F ratio in COVID-19 patients compared to methylprednisolone 28 Marla J Keller/UAS Observational study 1806 Steroids/No steroids 61.7 ± 15.9/62.3 ± 17.9 49.3%/46.3% COVID-19 patients Glucocorticoid increased mortality of patients with CRP< 10 mg/dL Early glucocorticoids (within 48 hours of admission) Choosing the right patients is critical to maximize the likelihood of benefit and minimize the risk of harm 29 Hong-Ming Zhu/China Single-center retrospective study 102 Steroids/No steroids Not mentioned 49.3%/57.6% Severe or critically ill log-rank 0.199, P = 0.655 Methylprednisolone 0.75–1.5 mg/kg/d, < 14 days Methylprednisolone treatment does not improve prognosis in severe and critical COVID-19 patients 30 Malgorzata Mikulska/Italy Observational single-center study 196...…”

Section: Pros and Cons Of Glucocorticoid Therapymentioning

confidence: 99%

Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19—Experience and Lessons from the SARS Epidemic

Zhang¹,

Wang²,

Shi³

et al. 2021

DDDT

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Effect of methylprednisolone in severe and critical COVID-19: Analysis of 102 cases

Cited by 14 publications

References 36 publications

Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

COVID-19: Considerations about immune suppression and biologicals at the time of SARS-CoV-2 pandemic

Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19—Experience and Lessons from the SARS Epidemic

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