Corticosteroids for hospitalized patients with mild to critically-ill COVID-19: a multicenter, retrospective, propensity score-matched study

Abstract

Corticosteroids use in coronavirus disease 2019 (COVID-19) is controversial, especially in mild to severe patients who do not require invasive/noninvasive ventilation. Moreover, many factors remain unclear regarding the appropriate use of corticosteroids for COVID-19. In this context, this multicenter, retrospective, propensity score–matched study was launched to evaluate the efficacy of systemic corticosteroid administration for hospitalized patients with COVID-19 ranging in the degree of severity from mild to critically-ill disease. This multicenter, retrospective study enrolled consecutive hospitalized COVID-19 patients diagnosed January–April 2020 across 30 institutions in Japan. Clinical outcomes were compared for COVID-19 patients who received or did not receive corticosteroids, after adjusting for propensity scores. The primary endpoint was the odds ratio (OR) for improvement on a 7-point ordinal score on Day 15. Of 1092 COVID-19 patients analyzed, 118 patients were assigned to either the corticosteroid and non-corticosteroid group, after propensity score matching. At baseline, most patients did not require invasive/noninvasive ventilation (85.6% corticosteroid group vs. 89.8% non-corticosteroid group). The odds of improvement in a 7-point ordinal score on Day 15 was significantly lower for the corticosteroid versus non-corticosteroid group (OR, 0.611; 95% confidence interval [CI], 0.388–0.962; p = 0.034). The time to improvement in radiological findings was significantly shorter in the corticosteroid versus non-corticosteroid group (hazard ratio [HR], 1.758; 95% CI, 1.323–2.337; p < 0.001), regardless of baseline clinical status. The duration of invasive mechanical ventilation was shorter in corticosteroid versus non-corticosteroid group (HR, 1.466; 95% CI, 0.841–2.554; p = 0.177). Of the 106 patients who received methylprednisolone, the duration of invasive mechanical ventilation was significantly shorter in the pulse/semi-pulse versus standard dose group (HR, 2.831; 95% CI, 1.347–5.950; p = 0.006). In conclusion, corticosteroids for hospitalized patients with COVID-19 did not improve clinical status on Day 15, but reduced the time to improvement in radiological findings for all patients regardless of disease severity and also reduced the duration of invasive mechanical ventilation in patients who required intubation.Trial registration: This study was registered in the University hospital Medical Information Network Clinical Trials Registry on April 21, 2020 (ID: UMIN000040211).

The Synergistic Inhibition of Coronavirus Replication and Induced Cytokine Production by Ciclesonide and the Tylophorine-Based Compound Dbq33b

“…Intervention strategies targeting the cytokine storm include traditional anti-inflammatories and immunosuppressives, e.g., corticosteroids such as dexamethasone and cyclosporine, as well as newly developed biologics, e.g., monoclonal antibodies targeting pro-inflammatory cytokines, and recombinant cytokines [ 4 , 5 ]. The current standard of care for hospitalized COVID-19 patients includes strategies to combat the cytokine storm such as dexamethasone and methylprednisolone [ 6 , 7 , 8 , 9 , 10 ], as well as those to address the replication of the virus itself [ 11 , 12 ], such as remdesivir. Any potential regimen that targets both the cytokine storm and viral replication merits further development.…”

Early steroids and ventilator-associated pneumonia in COVID-19-related ARDS

“…The reported association linking VAP to higher 28-day mortality in COVID-19-ARDS but not in other causes of ARDS supports a role for specific SARS-CoV-2-generated lung lesions in inducing greater VAP severity [ 22 ]. We assessed infections and mortality until day 90, whereas other studies usually stopped data collection on day 28 [ 23 , 24 ], notably a randomized clinical trial on the effect of corticosteroid therapy [ 10 ].…”

Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study

“… 43 Moreover, in some studies, low-dose corticosteroid therapy showed no effect on in-hospital mortality, mechanical ventilation, and viral clearance in patients with nonsevere COVID-19. 44 , 45 , 46 Thus, clinicians should carefully consider the risk versus benefit ratio and optimal dose of corticosteroid use for nonsevere patients with COVID-19.…”