The role and place of glucocorticosteroids in treatment of COVID-19 pneumonia without hypoxemia

Abstract

Introduction. The article presents the problems of the use of glucocorticosteroids in the treatment of patients with coronavirus– associated pneumonia (COVID-19) without hypoxemia. The experience of the preemptive use of low doses of glucocorticosteroids in the treatment of such patients in a hospital is described. Simplification of a unified scheme of pathogenetic therapy with glucocorticosteroids in the above patients is urgent. The article highlights the effectiveness of the early use of low doses of glucocorticosteroids in the treatment of a specific cohort of patients with COVID-19.Objective. To assess the clinical efficacy and safety of early use of small doses of methylprednisolone in the comprehensive therapy of patients with moderate to severe COVID-19 pneumonia to prevent the development of complications and improve the outcomes of the disease.Materials and methods. The study included 40 hospitalized patients from 37 to 68 years (average age 52. years) with a diagnosis of moderate to severe COVID-19 pneumonia. Patients were randomized into two groups: the main group (n = 20) and the control group (n = 20). The main group additionally received methylprednisolone: 4 mg tablets, 7 tablets per day, divided into 2 doses (4 tablets in the morning and 3 tablets at lunchtime). The effectiveness of the therapy was evaluated based on the primary combined endpoint of the study, which included progression of the disease to an extremely severe form or the occurrence of pulmonary and extrapulmonary complications that required transfer to the intensive care unit, or death of the patient during the followup period. The secondary combined endpoint of the study was resolution of clinical symptoms of the disease or achievement of reference values of laboratory and instrumental indicators.Results. No lethal outcomes were observed in the compared groups, there were no cases of development of an extremely severe course, complications requiring transfer to the intensive care unit in the main group.Conclusion. Early use of small doses methylprednisolone of in comprehensive therapy of patients with moderate and severe COVID-19 pneumonia reduces the incidence of life-threatening complications and improves the outcomes of the disease.

Results of the work of the Military medical academy research institute of novel coronavirus infection problems through 2020–2021

“…Опыт применения данных препаратов в клиниках ВМА у пациентов со среднетяжелым и тяжелым течением инфекции, вызванной SARS-CoV-2, показал, что упреждающая противовоспалительная терапия должна проводиться как можно раньше (в среднем на 7-8-й день болезни) до полного развития симптомокомплекса жизнеугрожающих состояний: специфического вирусного поражения легких, ОРДС, ДВС-синдрома и признаков полиорганной недостаточности. Оценка эффективности применения комплексной противовоспалительной терапии ГКС, игибиторами интерлейкина-6 и янус-киназ в терапии пациентов, болеющих новой коронавирусной инфекцией, в условиях клиники инфекционных болезней ВМА показала, что пациенты с выраженным провоспалительным ответом, своевременно получавшие данную терапию, демонстрировали статистически значимые более низкие показатели летальности (7,4 против 23%) по сравнению с группой пациентов, получавших терапию только ГКС [37][38][39].…”

Evaluation of Cellular Toxicity and Preclinical Safety of Using an Inhalable Liposomal form of Dexamethasone

“…Glucocorticosteroids are recognized efficacious agents for pathogenetic therapy of various types of pneumonia and acute respiratory distress syndrome (ARDS) [7]. Dexamethasone has been highly regarded around the world for the new COVID-19 coronavirus infection [8] as an agent for battling intoxication, inflammation, and sclerotic changes in the lungs [9].…”