Pulse steroid treatment for hospitalized adults with COVID-19

Abstract

Background/aim: High-dose steroid has been shown to reduce the mortality rate in Corona virus disease 2019 patients who need oxygen support. Here, we evaluated the effectiveness of pulse-steroid in case of unresponsiveness to treatment with high dose steroid. Materials and methods:The study is a retrospective controlled trial. We divided the patients in three groups: Standard-care therapy alone, high-dose steroid treatment (6 mg/day dexamethasone equivalent) and pulse-steroid treatment (250 mg/day methylprednisolone). One hundred fifty patients were enrolled in each group. All patients were hospitalized and needed oxygen support. We matched the patients according to disease severity at the onset of hypoxia, weight of co-morbidities, age and gender. We then compared three groups in terms of mortality, length of hospitalization, need for intensive care unit (ICU) admission and mechanical ventilation (MV), length of stay in ICU and duration of MV. Results:The pulse-steroid group had shorter ICU stay. The median ICU stay was 9.0(CI 95% 6.0-12.0) days in standard-care group, 8.0(CI 95% 5.0-13.0) days in highdose steroid group and 4.5(CI %95 3.0-8.0) days in pulse-steroid group. Moreover, although they were initially unresponsive to steroid therapy, they achieved similar results compared to the high-dose steroid group in other outcomes except for length of hospital stay. Conclusion:Pulse-steroid treatment would be an option for COVID-19 patients who do not respond to the initial high-dose steroid treatment.

Pulse versus nonpulse steroid regimens in patients with coronavirus disease 2019: A systematic review and meta‐analysis

“…Since then, there have been a number of studies comparing the two regimens with controversial results. While several studies showed similar mortality rates between PDS and NPDS regimens, 15–19 El mezzeoui et al demonstrated significantly decreased mortality in the PDS group compared to NPDS. On the contrary, Umbrello et al found that PDS was associated with increased mortality compared to NPDS.…”

“…Subsequently, we excluded 1558 studies because of the following: 1391 studies used inappropriate doses of steroids or lacked the appropriate comparison, 128 studies did not report data regarding the interventions of interest, and 39 studies were excluded due to lack of the appropriate outcomes of interest. Eventually, 10 studies met our inclusion criteria and were included in the meta‐analysis 14–19,22–25 . Figure 1 shows the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flow chart that illustrates how the final studies were selected.…”

“…[14][15][16] Several studies have compared PDS versus nonpulse dose steroids (NPDS) with conflicting results. 14,[17][18][19] Data regarding the role of PDS in COVID-19 are still unclear.…”

“…Newer studies showed that PDS could reduce the progression of COVID‐19 14–16 . Several studies have compared PDS versus nonpulse dose steroids (NPDS) with conflicting results 14,17–19 . Data regarding the role of PDS in COVID‐19 are still unclear.…”

“… 14 , 15 , 16 Several studies have compared PDS versus nonpulse dose steroids (NPDS) with conflicting results. 14 , 17 , 18 , 19 Data regarding the role of PDS in COVID‐19 are still unclear. Therefore, we performed this meta‐analysis to evaluate the effect of PDS versus NPDS on the clinical outcomes of patients with COVID‐19 pneumonia.…”