Short-Term Moderate-Dose Corticosteroid Plus Immunoglobulin Effectively Reverses COVID-19 Patients Who Have Failed Low-Dose Therapy

Abstract

Background:The coronavirus disease-19 has spread globally with more than 80,000 people infected, and nearly 3000 patients died. Currently, we are in an urgent need for effective treatment strategy to control the clinical deterioration of COVID-19 patients. Methods:The clinical data of 10 COVID-19 patients receiving short-term moderatedose corticosteroid (160mg/d) plus immunoglobulin (20g/d) were studied in the North Yard of The First Hospital of Changsha, Hunan from January 17 th to February 27 th , 2020. Epidemiological, clinical, laboratory, radiological findings were analyzed. Results: After treatment with combination of low-dose corticosteroid (40-80mg/d) and immunoglobulin (10g/d), patients' lymphocyte count (0.88±0.34 vs 0.59±0.18, P<0.05), oxygenation index including SPO2 (94.90±2.51 vs 90.50±5.91, P<0.05) and PaO2/FiO2 (321.36±136.91 vs 129.30±64.97, P<0.05) were significantly lower than pre-treatment, and CT showed that the pulmonary lesion deteriorated in all patients. While after treatment of short-term moderate-dose corticosteroid plus immunoglobulin, patients' APACHE Ⅱ score (9.10±6.15 vs 5.50±9.01, P<0.05), body temperature (37.59±1.16 vs 36.46±0.25, P<0.05), lymphocyte count (0.59±0.18 vs 1.36±0.51, P<0.05), Lactate dehydrogenase (419.24±251.31 vs 257.40±177.88, P<0.05), and C-reactive protein (49.94±26.21 vs 14.58±15.25, P<0.05) significantly improved compared with posttreatment with low-dose therapy. In addition, oxygenation index including SPO2 (90.50±5.91 vs 97.50±1.18, P<0.05), PaO2 (60.47±14.53 vs 99.07±34.31, P<0.05), and PaO2/FiO2 (129.30±64.97 vs 340.86±146.72, P<0.05) significant improved.

Non‐steroidal anti‐inflammatory drugs in management of COVID‐19; A systematic review on current evidence

“…5 For further investigation, the researchers of the present study evaluated all the existing reports on treatment of COVID-19 patients, which led to finding one clinical trial 4 and 12 case-report/ case-series studies. 1,3,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] There was no mention of prescribing NSAIDs in any of these studies. This might be because of no NSAID being prescribed, which is very unlikely; or it might just be that the In this study, use of ibuprofen has been suggested for controlling the patients' fever (fever over 38.5° Celsius).…”

Immune-epidemiological parameters of the novel coronavirus – a perspective

“…The first and ultimate picture of COVID-19 is a lung injury accompanied by a storm of pro-inflammatory cytokines. However, the use of anti-inflammatory drugs, e.g., corticosteroids, has its own adverse side-effects and more importantly, as demonstrated by a few avalabe studies [39][40][41], its effects on the clinical endpoints seem to be not more than standard anti-viral agents plus supportive care. Finding immune biomarkers that can distinguish severe-to-critical from mild-to-moderate infection would help to designate targets for immunotherapy of COVID-19.…”

Intravenous immunoglobulin immunotherapy for coronavirus disease‐19 (COVID‐19)

“…Currently, data are available from seven reports including the multicentre study of Shao et al that explored IVIG immunotherapy in the management of COVID-19 (Table 1). [5][6][7][8][9][10][11] These studies are mostly case series or retrospective, with an exception of one study that was randomised open-label trial. Although retrospective, data from Shao et al included large number of COVID-19 patients compared to other studies, and hence, data are more reliable.…”

“…Another report documented that short-term moderate-dose corticosteroid plus IVIG (20 g day À1 ) might effectively benefit COVID-19 patients who did not respond to low-dose therapy (10 g day À1 ). 6 The only randomised controlled study on IVIG also combined methylprednisolone. 8 In view of the corticosteroid combination, it is difficult to evaluate the therapeutic benefits of IVIG in these trials.…”