Corticosteroid therapy for patients with COVID-19 pneumonia: a before–after study

Abstract

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Early use of non-steroidal anti-inflammatory drugs in COVID-19 might reverse pathogenesis, prevent complications and improve clinical outcomes

“…Consistent with this recommendation, dexamethasone has been recently shown to lower COVID-19 28-day mortality only among patients who were receiving respiratory support [ 30 ]. However, a study with some limitations has showed that prednisone or methylprednisolone was associated with a significant reduction in COVID-19 hospital mortality and recommended initiation of clinical trials testing corticosteroids during the inflammatory phase of COVID-19 [ 31 ]. Similarly, 40–80 mg/d (0.75–1.5 mg/kg/d) of methylprednisolone for 3 days, tapered to 20 mg/d, with a total treatment period of less than 7 days benefited COVID-19 patients with marked radiologic progression and LDH levels of less than two times the upper limit number and a tailored individualized course was suggested as rescue treatment in more severe or critically ill patients [ 32 ].…”

Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

“…In 29 studies the dose of corticosteroids was reported: In 16 studies an equivalent dose of > 1 mg/kg prednisolone was used [37][38][39]41,43,44,[48][49][50][51]53,54,[56][57][58]64] and in 11 studies a lower equivalent dose than 1 mg/kg prednisolone [23,[34][35][36]40,42,47,52,62,63,65]. In two studies a low and high dose group were present [45,46].…”

“…The effect of corticosteroids on oxygenation was very heterogeneous: In four studies there was no signi cant effect [41,42,51,55], in three studies signi cant improvement was described [50,60,64] and in four studies worse outcome was observed. [35,39,54,57] Six studies addressed secondary infections. More frequently broad spectrum antibiotics were used in de corticosteroid group [39,47,53] and more secondary infections/sepsis episodes were described [35,36].…”

“…[35,39,54,57] Six studies addressed secondary infections. More frequently broad spectrum antibiotics were used in de corticosteroid group [39,47,53] and more secondary infections/sepsis episodes were described [35,36]. Only Tomazini found a lower percentage of secondary infections in the corticosteroid group.…”

Possible synergistic effects of hydroxychloroquine and steroids in COVID-19, time for a nuanced approach. Comment on Arshad et al.

“…With much lower HCQ usage, a similar pre/post study ( Table 1 ( Bani-Sadr et al, 2020 )) found steroid-associated reduced mortality, but only after multivariate adjustment. These studies support the early combined in-hospital use of HCQ and MPD to reduce mortality and the need for ventilation.…”