Background: There is no proven antiviral or immunomodulatory therapy for COVID-19. The disease progression associated with the pro-inflammatory host response prompted us to examine the role of early corticosteroid therapy in patients with moderate to severe COVID-19.
Methods: We conducted a single pre-test, single post-test quasi-experiment in a multi-center health system in Michigan from March 12 to March 27, 2020. Adult patients with confirmed moderate to severe COVID were included. A protocol was implemented on March 20, 2020 using early, short-course, methylprednisolone 0.5 to 1 mg/kg/day divided in 2 intravenous doses for 3 days. Outcomes of standard of care (SOC) and early corticosteroid groups were evaluated, with a primary composite endpoint of escalation of care from ward to ICU, new requirement for mechanical ventilation, and mortality. All patients had at least 14 days of follow-up.
Results: We analyzed 213 eligible subjects, 81 (38%) and 132 (62%) in SOC and early corticosteroid groups, respectively.The composite endpoint occurred at a significantly lower rate in the early corticosteroid group (34.9% vs. 54.3%, p=0.005). This treatment effect was observed within each individual component of the composite endpoint. Significant reduction in median hospital length of stay was also observed in the early corticosteroid group (8 vs. 5 days, p < 0.001). Multivariate regression analysis demonstrated an independent reduction in the composite endpoint at 14-days controlling for other factors (aOR: 0.41; 95% CI [0.22 - 0.77]).
Conclusion: An early short course of methylprednisolone in patients with moderate to severe COVID-19 reduced escalation of care and improved clinical outcomes.
Keywords: COVID-19; Corticosteroids; SARS-COV-2; coronavirus; outcomes.
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: firstname.lastname@example.org.
Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a rapid review.Cochrane Database Syst Rev. 2020 May 14;5:CD013600. doi: 10.1002/14651858.CD013600. Cochrane Database Syst Rev. 2020. PMID: 32406927
Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis.Leukemia. 2020 Jun;34(6):1503-1511. doi: 10.1038/s41375-020-0848-3. Epub 2020 May 5. Leukemia. 2020. PMID: 32372026 Free PMC article. Review.
Focus on Receptors for Coronaviruses with Special Reference to Angiotensin-converting Enzyme 2 as a Potential Drug Target - A Perspective.Endocr Metab Immune Disord Drug Targets. 2020 Apr 27. doi: 10.2174/1871530320666200427112902. Online ahead of print. Endocr Metab Immune Disord Drug Targets. 2020. PMID: 32338224
[Repurposing of chlorpromazine in COVID-19 treatment: the reCoVery study].Encephale. 2020 Apr 29:S0013-7006(20)30079-8. doi: 10.1016/j.encep.2020.04.010. Online ahead of print. Encephale. 2020. PMID: 32387014 Free PMC article. French.
Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease.Cochrane Database Syst Rev. 2014 Sep 1;(9):CD001288. doi: 10.1002/14651858.CD001288.pub4. Cochrane Database Syst Rev. 2014. PMID: 25178099 Review.