High-dose versus low-dose prednisolone in symptomatic patients with post-COVID-19 diffuse parenchymal lung abnormalities: an open-label, randomised trial (the COLDSTER trial)

Abstract

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Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, India

“… 91 In patients with prolonged hypoxaemia due to COVID-19 or post-COVID-19 lung abnormalities, when a longer duration of glucocorticoids might be needed, the lowest possible dose of glucocorticoids should be used (along with strict glycaemic control). 92 …”

A multicenter survey study of antifibrotic use for symptomatic patients with post-COVID-19 interstitial lung abnormalities

“…A recent RCT showed that low-dose prednisolone (10 mg/day for six weeks) might be sufficient to achieve significant clinico-physiologic and radiologic improvement in patients with severe PC-ILAS. [ 5 ] Thus, it is probable that most patients with PC-ILAS have an inflammatory lung disease that improves spontaneously over time. Few patients might have a persistent OP and may require glucocorticoids if they do not improve over the ensuing weeks.…”

“…There is a single randomised controlled trial (RCT, of prednisolone) and a few observational studies of glucocorticoids and antifibrotics for the treatment of PC-ILAS. [ 4 5 6 7 8 ] The antifibrotic drugs, pirfenidone and nintedanib, have anti-inflammatory and antifibrotic properties by their action on various pathways and are effective in idiopathic pulmonary fibrosis (IPF) and other progressive fibrosing ILDs. [ 9 10 11 12 13 ] It has been proposed that they may be useful in PC-ILAS; however, the opinion on their potential utility remains divided.…”

“…[ 9 10 11 12 13 ] It has been proposed that they may be useful in PC-ILAS; however, the opinion on their potential utility remains divided. [ 4 5 6 7 9 10 11 14 15 16 17 18 19 ] In the absence of evidence, several physicians prescribe antifibrotic drugs to patients with PC-ILAS based on biological plausibility. [ 5 6 7 17 ] Herein, we describe a multicenter study, wherein we aimed to explore physician practices of prescribing antifibrotic agents to patients with PC-ILAS.…”

“…[ 4 5 6 7 9 10 11 14 15 16 17 18 19 ] In the absence of evidence, several physicians prescribe antifibrotic drugs to patients with PC-ILAS based on biological plausibility. [ 5 6 7 17 ] Herein, we describe a multicenter study, wherein we aimed to explore physician practices of prescribing antifibrotic agents to patients with PC-ILAS. We hypothesized that a significant number of patients are prescribed these agents based on physician discretion.…”