Repeated pulses of methyl-prednisolone in COVID-19 pneumonia and acute respiratory distress syndrome

 MichelleEspinosa-Solanoa1DemetrioGonzalez-Vergaraa1MartaFerrer-Galvana1Maria IsabelAsensio-Cruzab1Jose MLomascCristinaRoca-OportocMaria DoloresNavarro-AmuedocMariaPaniagua-GarciacCesarSotomayorcNuriaEspinosacManuelGarcia-GutierrezcJose MolinaGil-BermejocManuelaAguilar-GuisadocManuelPoyatocJuliaPraena-SegoviacAlejandroPalomodMacarenaBorrero-RodriguezdElisaCorderoc…LuisJara-Palomaresab2

https://doi.org/10.1016/j.opresp.2021.100086

PDF: https://www.sciencedirect.com/science/article/pii/S2659663621000059/pdf?md5=994bc456b733cfd84dedf935e3a1f2c9&pid=1-s2.0-S2659663621000059-main.pdf

Abstract

Introduction

The use of systemic corticosteroids in severely ill patients with coronavirus disease 2019 (COVID-19) is controversial. We aimed to evaluate the efficacy and safety of corticosteroid pulses in patients with COVID-19 pneumonia.

Methods

A quasi-experimental study, before and after, was performed in a tertiary referral hospital, including admitted patients showing COVID-19-associated pneumonia. The standard treatment protocol included targeted COVID-19 antiviral therapy from 23th March 2020, and additionally pulses of methylprednisolone from 30th March 2020. The primary outcome was a composite endpoint combining oro-tracheal intubation (OTI) and death within 7 days.

Results

A total of 24 patients were included. Standard of care (SOC) (before intervention) was prescribed in 14 patients, while 10 received SOC plus pulses of methylprednisolone (after intervention). The median age of patients was 64.5 years and 83.3% of the patients were men. The primary composite endpoint occurred in 13 patients (92.9%) who received SOC vs. 2 patients (20%) that received pulses of methylprednisolone (odds ratio, 0.02; 95% confidence interval, 0.001 to 0.25; P = 0.019). Length of hospitalization in survivors was shorter in the corticosteroids group (median, 14.5 [8.5 to 21.8] days vs. 29 [23 to 31] days, P = 0.003). There were no differences in the development of infections between both groups. There were 3 deaths, none of them in the corticosteroids group.

Conclusions

In patients with severe pneumonia due to COVID-19, the administration of methylprednisolone pulses was associated with a lower rate of OTI and /or death and a shorter hospitalization episode.

https://www.sciencedirect.com/science/article/pii/S2659663621000059