Successful treatment with methyl-prednisolone pulses for the late phase of COVID-19 with respiratory failure: A single-center case series

Tamura, Kentaro; Nishioka, Saiko; Tamura, Nobumasa; Saito, Zenya; Kuwano, Kazuyoshi

doi:10.1016/j.rmcr.2020.101318

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…10 The scales gradually tipped in the other direction thanks to the realization that SARS-CoV-2 may produce lung damage by igniting a destructive immune response in that organ rather than through direct viral cytopathic effects 11 and the corollary that viral persistence may not be the driver of progressive 17) 60 ( 16) 66 ( 13 (Continues) lung disease in SARS-CoV-2. 12 Once RCTs evaluating corticosteroid therapy were launched, the dosing regimens resembled those of favorable prior studies of early corticosteroid administration in mixed ARDS populations: for example, methylprednisolone 1 mg/kg/day in the trial by Meduri et al 13 and dexamethasone 20 mg once daily followed by 10 mg once daily in the trial by Villar et al 14 The belief in some circles that COVID-19 pneumonia differs from routine ARDS in the degree of maladaptive exaggeration of the lung immune response led to sporadic reports [15][16][17][18] of the use of corticosteroids at pulse dose of 1 gm/day for at least 2 days as defined in the present study and as might be done for immune-mediated lung diseases such as pulmonary vasculitis or primary lung allograft dysfunction. Administration of corticosteroids at this magnitude has not been studied systematically in any COVID-19 pneumonia population before the present study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of pulse‐dose and high‐dose corticosteroids with no corticosteroid treatment for COVID‐19 pneumonia in the intensive care unit

Yaqoob

Greenberg

Hwang

et al. 2021

Journal of Medical Virology

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Corticosteroid dosing in the range of 0.5–2 mg/kg/day of methylprednisolone equivalents has become a standard part of the management of intensive care unit (ICU) patients with COVID‐19 pneumonia based on positive results of randomized trials and a meta‐analysis. Alongside such conventional dosing, administration of 1 gm of methylprednisolone daily (pulse dosing) has also been reported in the literature with claims of favorable outcomes. Comparisons between such disparate approaches to corticosteroids for Coronavirus disease 2019 (COVID‐19) pneumonia are lacking. In this retrospective study of patients admitted to the ICU with COVID‐19 pneumonia, we compared patients treated with 0.5–2 mg/kg/day in methylprednisolone equivalents (high‐dose corticosteroids) and patients treated with 1 gm of methylprednisolone (pulse‐dose corticosteroids) to those who did not receive any corticosteroids. The endpoints of interest were hospital mortality, ICU‐free days at Day 28, and complications potentially attributable to corticosteroids. Pulse‐dose corticosteroid therapy was associated with a significant increase in ICU‐free days at Day 28 compared to no receipt: adjusted relative risk (aRR): 1.45 (95% confidence interval [CI]: 1.05–2.02; p = 0.03) and compared with high‐dose corticosteroid administration (p = 0.003). Nonetheless, receipt of high‐dose corticosteroids—but not of pulse‐dose corticosteroids—significantly reduced the odds of hospital mortality compared to no receipt: adjusted Odds ratio (aOR) 0.31 (95% CI: 0.12–0.77; p = 0.01). High‐dose corticosteroids reduced mortality compared to pulse‐dose corticosteroids (p = 0.04). Pulse‐dose corticosteroids—but not high‐dose corticosteroids—significantly increased the odds of acute kidney injury requiring renal replacement therapy compared to no receipt: aOR 3.53 (95% CI: 1.27–9.82; p = 0.02). The odds of this complication were also significantly higher in the pulse‐dose group when compared to the high‐dose group (p = 0.05 for the comparison). In this single‐center study, pulse‐dose corticosteroid therapy for COVID‐19 pneumonia in the ICU was associated with an increase in ICU‐free days but failed to impact hospital mortality, perhaps because of its association with development of severe renal failure. In line with existing trial data, the effect of high‐dose corticosteroids on mortality was favorable.

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Section: Discussionmentioning

confidence: 99%

Comparison of pulse‐dose and high‐dose corticosteroids with no corticosteroid treatment for COVID‐19 pneumonia in the intensive care unit

Yaqoob

Greenberg

Hwang

et al. 2021

Journal of Medical Virology

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“…Thereupon, we started pulse steroid therapy, which has been shown to be beneficial for the late phase of COVID-19 with respiratory failure. 10 Since hypoxia did not improve, pirfenidone was initiated with the decision of the council.…”

Section: Discussionmentioning

confidence: 99%

Anti-fibrotic Treatment for Pulmonary Fibrosis Induced by COVID-19: A Case Presentation

Uyar¹,

Ensarioglu²,

Kurt³

et al. 2022

Turk J Anaesthesiol Reanim

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“…Edalatifard et al reported that 250 mg/day steroid pulse therapy for 3 days resulted in a significantly higher clinical improvement and a lower mortality rate than the control group [ 17 ]. In a report from Japan, Tamura et al reported the therapeutic effect of high-dose steroid pulse therapy (1 g of methylprednisolone (mPSL) for 3 days) [ 18 ]. Furthermore, Pinzon et al reported that high-dose methylprednisolone for 3 days followed by oral prednisone for 14 days reduced recovery time and the need for intensive care compared to 6 mg dexamethasone for 7–10 days [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Committee report: Questionnaire survey on the treatment of COVID-19 in patients receiving dialysis therapy

et al. 2022

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Background Patients with coronavirus disease 2019 (COVID-19) who receive dialysis therapy develop more severe disease and have a poorer prognosis than patients who do not. Although various data on the treatment of patients not receiving dialysis therapy have been reported, clinical practice for patients on dialysis is challenging as data is limited. The Infection Control Committee of the Japanese Society for Dialysis Therapy decided to clarify the status of treatment in COVID-19 patients on dialysis. Methods A questionnaire survey of 105 centers that had treated at least five COVID-19 patients on dialysis was conducted in August 2021. Results Sixty-six centers (62.9%) responded to the questionnaire. Antivirals were administered in 27.7% of facilities treating mild disease (most patients received favipiravir) and 66.7% of facilities treating moderate disease (most patients with moderate or more severe conditions received remdesivir). Whether and how remdesivir is administered varies between centers. Steroids were initiated most frequently in moderate II disease (50.8%), while 43.1% of the facilities initiated steroids in mild or moderate I disease. The type of steroid, dose, and the duration of administration were generally consistent, with most facilities administering dexamethasone 6 mg orally or 6.6 mg intravenously for 10 days. Steroid pulse therapy was administered in 48.5% of the facilities, and tocilizumab was administered in 25.8% of the facilities, mainly to patients on ventilators or equivalent medications, or to the cases of exacerbations. Furthermore, some facilities used a polymethylmethacrylate membrane during dialysis, nafamostat as an anticoagulant, and continuous hemodiafiltration in severe cases. There was limited experience of polymyxin B-immobilized fiber column-direct hemoperfusion and extracorporeal membrane oxygenation. The discharge criteria for patients receiving dialysis therapy were longer than those set by the Ministry of Health, Labor and Welfare in 22.7% of the facilities. Conclusions Our survey revealed a variety of treatment practices in each facility. Further evidence and innovations are required to improve the prognosis of patients with COVID-19 receiving dialysis therapy.

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Successful treatment with methyl-prednisolone pulses for the late phase of COVID-19 with respiratory failure: A single-center case series

Cited by 11 publications

References 10 publications

Comparison of pulse‐dose and high‐dose corticosteroids with no corticosteroid treatment for COVID‐19 pneumonia in the intensive care unit

Comparison of pulse‐dose and high‐dose corticosteroids with no corticosteroid treatment for COVID‐19 pneumonia in the intensive care unit

Anti-fibrotic Treatment for Pulmonary Fibrosis Induced by COVID-19: A Case Presentation

Committee report: Questionnaire survey on the treatment of COVID-19 in patients receiving dialysis therapy

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