Effects of methylprednisolone use on viral genomic nucleic acid negative conversion and CT imaging lesion absorption in COVID‐19 patients under 50 years old

Gong, Yuan; Guan, Li; Zhu, Jian; Chen, Shixiong; Xiang, Guangming; Gao, Baoan

doi:10.1002/jmv.26052

Cited by 32 publications

(32 citation statements)

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“…The indication for corticosteroids was reported in 7/22 studies and varied: most frequently it comprised (a combination of) worsening oxygenation, severe radiological ndings, ICU admission, or persistence of in ammatory symptoms. [33,[38][39][40][41][42][43] The median time of initiation after admission was reported in 8/22 studies and varied from 24 hours after hospital admission, [44] immediately after ICU admission [43] to approximately eight to fourteen days after onset of symptoms. [23,41,42,[45][46][47] One study compared early (average 2 days after hospital admission) to late corticosteroid administration (average 5 days after hospital admission).…”

Section: Resultsmentioning

confidence: 99%

“…[33] Methylprednisolone was the most frequently used corticosteroid (13/22 studies). [33,[37][38][39][40][42][43][44]46,[48][49][50][51] In two studies methylprednisolone, hydrocortisone, or dexamethasone was used. [36,41] Ling et al used prednisolone or dexamethasone, [52] and Horby et al reported on dexamethasone use.…”

Section: Resultsmentioning

confidence: 99%

“…In most studies a low dose methylprednisolone was administered, ranging from 0.5 to 2 mg/kg body weight per 24 hours. [33,38,40,42 Mortality (see also Table 2) Fourteen studies reported mortality, including in-hospital and 28-day mortality. In four of these, mortality was only described in the overall study population and not speci ed for steroid or non-steroid study groups.…”

Section: Resultsmentioning

confidence: 99%

“…[50] However, Lu et al did note that every increase of 10 mg in hydrocortisone equivalent dosage was associated with a 4% elevation of the mortality risk (HR 1.04, 95% CI 1.01-1.07). [36] Viral clearance [38,50,52,53] Three did not adjust for confounders. [38,50,52] The additional information possibly affecting viral clearance, i.e.…”

Section: Resultsmentioning

confidence: 99%

“…[36] Viral clearance [38,50,52,53] Three did not adjust for confounders. [38,50,52] The additional information possibly affecting viral clearance, i.e. timing, dose, and duration of corticosteroid therapy, and study population, was not consistently reported nor did show a consistent trend (Table 1 and 2).…”

Section: Resultsmentioning

confidence: 99%

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Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

Hoekstra

Neumann

Boot

et al. 2020

Preprint

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Background In the current SARS-CoV-2 pandemic, there has been worldwide debate on the use of corticosteroids in COVID-19. In a recent RCT (RECOVERY trial), a reduced 28-day mortality in patients requiring oxygen therapy or mechanical ventilation evaluating the effect of dexamethasone was shown. Their results have led to considering amendments in guidelines or actually already recommending corticosteroid use in COVID-19. However, the supposed effect of corticosteroids on mortality and viral clearance remains unclear and a clear evidence-based therapeutic strategy is still lacking.Objectives The aim of this systematic review and meta-analysis was to evaluate the effect of corticosteroids on mortality, viral clearance and secondary outcomes in COVID-19 patients.Data source, study eligibility, participants, interventionsA systematic literature search was performed across Medline/PubMed, Embase, and Web of Science from 1st of December 2019 until 10th of July 2020, according to the PRISMA guidelines. RCTs and cohort studies reporting in English, on ≥15 adult COVID-19 patients, treated with any type of corticosteroid therapy were included. Studies on pregnant women, reviews and with a NOS (Newcastle Ottawa Scale for validity assessment of observational studies) score of ≤4 were excluded.Results Twenty-two articles were included, covering 9,760 patients. In eight studies, the effect of corticosteroid use was quantified. The pooled estimate of the observational studies supported the positive effect on mortality of corticosteroid therapy in COVID-19 as reported in the RECOVERY trial, in respiratory compromised COVID-19 patients, i.e. oxygen or mechanical ventilation dependent or with ARDS. The overall pooled estimate (observational studies and the RCT) showed reduced mortality in the corticosteroid group (relative risk 0.55 [95% CI 0.27-0.83]). Furthermore, mechanical ventilation rate seemed lower in corticosteroid treated COVID-19 patients, though no definite conclusions could be drawn because of a low number of studies. With regard to potential side effects of corticosteroids, the effect on viral clearance duration was ambiguous, i.e. prolonged in 4 of 9 and without effect in 5 of 9 studies.Conclusions It appears safe with respect to viral clearance to administer corticosteroids in respiratory compromised COVID-19 patients with possible improvement in mortality and conflicting effects on viral clearance.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

Hoekstra

Neumann

Boot

et al. 2020

Preprint

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Effects of methylprednisolone use on viral genomic nucleic acid negative conversion and CT imaging lesion absorption in COVID‐19 patients under 50 years old

Gong

Guan

Zhu

et al. 2020

Journal of Medical Virology

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The use of corticosteroids has been controversial in viral pneumonia. In most cases, application of methylprednisolone in severe and critical viral pneumonia patients can quickly alleviate the symptoms of dyspnea and prevent disease progression. However, some scholars have confirmed that corticosteroids delayed the body's clearance of the virus. In our retrospective non-randomized study, 34 patients under 50 years old and diagnosed with coronavirus disease 2019 (COVID-19) were included. According to the given methylprednisolone treatment (n = 18) or not (n = 16), they were separated into two groups. By comparing the clinical data we concluded that corticosteroids therapy can effectively release COVID-19 symptoms such as persistent fever and difficult in breathing, improve oxygenation, and prevent disease progression. However, it can prolong the negative conversion of nucleic acids.

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Corticosteroids in COVID-19: Is it Rational? A Systematic Review and Meta-Analysis

Budhathoki¹,

Shrestha²,

Rawal

et al. 2020

SN Compr. Clin. Med.

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Due to a lack of definitive treatment, many drugs were repurposed for Coronavirus disease (COVID-19) treatment; among them, corticosteroid is one. However, its benefit or harm while treating COVID-19 is not fully studied. Thus, we conducted this meta-analysis to assess the rationality on the use of corticosteroids in COVID-19. Pubmed, Medline, Clinicaltrials.gov, Cochrane library, and Preprint publisher were searched. In the qualitative syntheses, 41, and quantitative studies, 40, were included using PRISMA guidelines. Assessment of heterogeneity was done using the I-squared (I 2) test and random/fixed effect analysis was done to determine the odds/risk ratio. We found severely ill COVID-19 patients almost 5 (OR 4.78, 2.76-8.26) times higher odds of getting corticosteroids during their treatment. Similarly, the odds for corticosteroids in addition to standard of care (SOC) were approximately 4 (OR 4.09, 1. 89-8.84) times higher among intensive care unit (ICU) patients than non-ICU ones. A higher mortality risk with the corticosteroidreceiving group compared with the SOC alone (RR 2.01, 1.12-3.63) was observed. Neither increased discharge rate (RR 0.79, 0.63-0. 99) nor recovery/improvement rate was shown among the corticosteroid-receiving group (OR 0.24, 0.13-0.43). Approximately, the overall 4-day longer hospital stay was found among the treatment groups (MD 4.19, 2.57-5.81). For the negative conversion of reverse transcription-polymerase chain reaction (RT-PCR), approximately a 3-day (MD 2.42, 1.31-3.53) delay was observed with corticosteroid treatment cases. Our study concludes that more severe and critically ill patients tend to get corticosteroids, and the mortality risk increases with the use of corticosteroids. With the use of corticosteroids, delayed recovery and a longer hospital stay were observed.

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Effects of methylprednisolone use on viral genomic nucleic acid negative conversion and CT imaging lesion absorption in COVID‐19 patients under 50 years old

Cited by 32 publications

References 18 publications

Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

Effects of methylprednisolone use on viral genomic nucleic acid negative conversion and CT imaging lesion absorption in COVID‐19 patients under 50 years old

Corticosteroids in COVID-19: Is it Rational? A Systematic Review and Meta-Analysis

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