Effects of Short-Term Low-Dose Glucocorticoids for Patients with Mild COVID-19

Abstract

Objectives. To evaluate the role of short-term low-dose glucocorticoids in mild COVID-19 patients. Methods. We conducted a retrospective, cross-sectional, single-center study in Kunming, China. A total of 33 mild COVID-19 cases were divided into two treatment groups (with and without glucocorticoids, methylprednisolone, were used in this setting), and the absolute value of peripheral blood lymphocyte count; CD3+, CD4+, and CD8+ T cell counts; and the time to achieve negative transformation of a nucleic acid pharyngeal swab were recorded. Peripheral blood lymphocyte and T cell counts were compared between the treatment group and 25 healthy individuals. At the point of time when there was a 50% accumulation conversion rate (positive to negative nucleic acid on pharyngeal swab), and the nucleic acid turned negative in half of the patients in two groups, the peripheral blood lymphocyte and T cell counts were compared between treatment groups. Results. The mean cumulative time for the 50% negative conversion rate of the nucleic acid in the pharyngeal swab was 17.7±5.1 days and 13.9±5.4 days in the glucocorticoid group and the nonglucocorticoid group, respectively. The absolute peripheral blood lymphocyte count and the T cell subset count in the glucocorticoid group were lower than those in the nonglucocorticoid group. When the nucleic acid turned negative in half of the patients, the absolute value of peripheral blood lymphocyte count and CD4+ T cells of the glucocorticoid group and the nonglucocorticoid group was not significantly different; the CD3+ and CD8+ T cells in the glucocorticoid group were lower than those in the nonglucocorticoid group. The absolute peripheral blood lymphocyte count, CD3+ T cells, and CD4+ T cells in the glucocorticoid group were lower than those of the healthy group during the whole disease period, and CD8+ T cells returned to normal at 19-21 days of the disease period. There was no significant difference between the nonglucocorticoid group and the healthy group for absolute peripheral blood lymphocyte and CD8+ T cells; moreover, CD3+ T cells and CD4+ T cells were lower in the nonglucocorticoid group than those in the healthy group from the day of admission to the 18th day and returned to normal at the period of 19-21 days. The absolute peripheral lymphocyte count (P=0.048, effect size d=0.727) and T cell subset count (CD3: P=0.042, effect size d=0.655; CD4: P<0.01, effect size d=0.599; and CD8: P=0.034, effect size d=0.550) in the nonglucocorticoid group were higher than those in the glucocorticoid group, and the difference between the groups was statistically significant. Conclusions. This study found that the use of short-term, low-dose glucocorticoids does not negatively influence the clinical outcome, without affecting the final clearance of viral nucleic acid in mild COVID-19 patients.

Glucocorticoids are double-edged sword in the treatment of COVID-19 and cancers

“…However, the limitation of RECOVERY study is that the side effects of glucocorticoids are not adequately assessed. Thereafter, the efficacy of glucocorticoids in the treatment of COVID-19 has been reported by different groups from different countries [29][30][31]. Keller et al reported that glucocorticoids could significantly reduce the risk of mortality or mechanical ventilation (odds ratio, 0.23; 95% CI, 0.08-0.70) if the initial level of C-reactive protein (CRP) is >/=20 mg/dl.…”

Safety and Efficacy of Low-Dose Corticosteroids in Patients With Non-severe Coronavirus Disease 2019: A Retrospective Cohort Study

“…At present, there is a dearth of data evaluating the efficacy of a low-dose, short-course corticosteroid regimen in the treatment of a non-severe COVID-19 infection. Some studies have posited that the early administration of low-dose, short-course corticosteroids in mild and moderate COVID-19 cases has the potential to halt the progression of the disease process and improve clinical outcomes with no added adverse effects [6,7]. are mediated by the 1 1 2, 3 1 1 4 1 1 1 1 binding of glucocorticoids (GC) to GC receptors, thereby inhibiting the transcription of cytokines such as interleukin 6 (IL-6) that remain a hallmark of an aberrant immune response characteristic of a COVID-19 infection [8].…”

“…At present, there is a dearth of data evaluating the efficacy of a low-dose, short-course corticosteroid regimen in the treatment of a non-severe COVID-19 infection. Some studies have posited that the early administration of low-dose, short-course corticosteroids in mild and moderate COVID-19 cases has the potential to halt the progression of the disease process and improve clinical outcomes with no added adverse effects [ 6 , 7 ].…”

When to call it off: Defining the role of low-dose corticosteroids in thwarting the progression of non-severe COVID-19

“…Moreover, a number of studies have vouched against the use of corticosteroids in the early phases of COVID-19, citing their immunosuppressive effects, delaying of viral clearance, and numerous complications as evidenced by their anecdotal use in the middle eastern respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) outbreaks [ 7 ]. In contrast, the early administration of low-dose corticosteroids for a short-term in non-severe COVID-19 infections has the potential to thwart the rapid progression of the disease course and ameliorate clinical outcomes while minimizing unnecessary harm [ [8] , [9] , [10] ]. To this date, there is scarcity of data regarding the efficacy and safety of low-dose corticosteroids for a short-term in the treatment of mild and moderate cases of COVID-19.…”