#Drug #treatments for #covid19: living systematic #review and network meta-analysis (BMJ, abstract)

[Source: British Medical Journal, full page: (LINK). Abstract, edited.]

Drug treatments for covid-19: living systematic review and network meta-analysis

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2980 (Published 30 July 2020)

Cite this as: BMJ 2020;370:m2980

Reed AC Siemieniuk , methodologist, internist1 *,  Jessica J Bartoszko, methodologist1 *,  Long Ge, methodologist2 *,  Dena Zeraatkar, methodologist1 *,  Ariel Izcovich, methodologist, internist3,  Hector Pardo-Hernandez, methodologist45,  Bram Rochwerg, methodologist, critical care physician16,  Francois Lamontagne, methodologist, critical care physician7,  Mi Ah Han, methodologist8,  Elena Kum, methodologist1,  Qin Liu, professor910,  Arnav Agarwal, methodologist, internist111,  Thomas Agoritsas, methodologist, internist112,  Paul Alexander, methodologist, assistant professor1,  Derek K Chu, methodologist, immunologist16,  Rachel Couban, librarian13,  Andrea Darzi, methodologist1,  Tahira Devji, methodologist1,  Bo Fang, methodologist910,  Carmen Fang, registered nurse14,  Signe Agnes Flottorp, senior researcher1516,  Farid Foroutan, methodologist117,  Diane Heels-Ansdell, statistician1,  Kimia Honarmand, methodologist, critical care physician3,  Liangying Hou, medical doctor candidate2,  Xiaorong Hou, librarian18,  Quazi Ibrahim, statistician1,  Mark Loeb, methodologist, infectious disease physician16,  Maura Marcucci, methodologist, internist16,  Shelley L McLeod, methodologist, assistant professor1920,  Sharhzad Motaghi, methodologist1,  Srinivas Murthy, clinical associate professor, pediatric critical care, infectious diseases physician21,  Reem A Mustafa, associate professor, nephrologist122,  John D Neary, methodologist, internist3,  Anila Qasim, research associate1,  Gabriel Rada, methodologist2324,  Irbaz Bin Riaz, methodologist, internist25,  Behnam Sadeghirad, assistant professor113,  Nigar Sekercioglu, assistant professor1,  Lulu Sheng, methodologist910,  Charlotte Switzer, methodologist1,  Britta Tendal, methodologist26,
Lehana Thabane, professor1,  George Tomlinson, senior biostatistician27,  Tari Turner, senior research fellow26,  Per O Vandvik, methodologist, internist14,  Robin WM Vernooij, methodologist2829,  Andrés Viteri-García, methodologist2330,  Ying Wang, methodologist, pharmacist1,  Liang Yao, methodologist1,  Zhikang Ye, methodologist, pharmacist1,  Gordon H Guyatt, methodologist, internist16,  Romina Brignardello-Petersen, methodologist1

Correspondence to: R Siemieniuk reed.siemieniuk@medportal.ca

Accepted 23 July 2020

 

Abstract

Objective 

To compare the effects of treatments for coronavirus disease 2019 (covid-19).

Design 

Living systematic review and network meta-analysis.

Data sources 

US Centers for Disease Control and Prevention COVID-19 Research Articles Downloadable Database, which includes 25 electronic databases and six additional Chinese databases to 20 July 2020.

Study selection 

Randomised clinical trials in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles.

Methods 

After duplicate data abstraction, a bayesian random effects network meta-analysis was conducted. Risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach. For each outcome, interventions were classified in groups from the most to the least beneficial or harmful following GRADE guidance.

Results 

23 randomised controlled trials were included in the analysis performed on 26 June 2020. The certainty of the evidence for most comparisons was very low because of risk of bias (lack of blinding) and serious imprecision. Glucocorticoids were the only intervention with evidence for a reduction in death compared with standard care (risk difference 37 fewer per 1000 patients, 95% credible interval 63 fewer to 11 fewer, moderate certainty) and mechanical ventilation (31 fewer per 1000 patients, 47 fewer to 9 fewer, moderate certainty). These estimates are based on direct evidence; network estimates for glucocorticoids compared with standard care were less precise because of network heterogeneity. Three drugs might reduce symptom duration compared with standard care: hydroxychloroquine (mean difference −4.5 days, low certainty), remdesivir (−2.6 days, moderate certainty), and lopinavir-ritonavir (−1.2 days, low certainty). Hydroxychloroquine might increase the risk of adverse events compared with the other interventions, and remdesivir probably does not substantially increase the risk of adverse effects leading to drug discontinuation. No other interventions included enough patients to meaningfully interpret adverse effects leading to drug discontinuation.

Conclusion 

Glucocorticoids probably reduce mortality and mechanical ventilation in patients with covid-19 compared with standard care. The effectiveness of most interventions is uncertain because most of the randomised controlled trials so far have been small and have important study limitations.

Systematic review registration 

This review was not registered. The protocol is included as a supplement.

Readers’ note 

This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.

Keywords: SARS-CoV-2; COVID-19; Antivirals; Remdesivir; Chloroquine; Lopinavir; Corticosteroids.

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#COVID19 and #Dexamethasone – A Potential #Strategy to Avoid Steroid-Related #Strongyloides #Hyperinfection (JAMA, summary)

[Source: JAMA, full page: (LINK). Summary, edited.]

COVID-19 and Dexamethasone – A Potential Strategy to Avoid Steroid-Related Strongyloides Hyperinfection

William M. Stauffer, MD, MSPH1,2; Jonathan D. Alpern, MD3,4; Patricia F. Walker, MD, DTM&H2,3

Author Affiliations: 1 Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis; 2 Department of Medicine, Global Medicine, University of Minnesota, Minneapolis; 3 HealthPartners Institute, Bloomington, Minnesota; 4 HealthPartners Travel and Tropical Medicine Center, St Paul, Minnesota

JAMA. Published online July 30, 2020. doi:10.1001/jama.2020.13170

___

A widely publicized press release and subsequent preliminary report of the RECOVERY trial, a randomized study conducted in the UK, noted a survival benefit with the use of dexamethasone in hospitalized patients with coronavirus disease 2019 (COVID-19).1 The use of dexamethasone for management of COVID-19 has already increased, particularly given the recent National Institutes of Health COVID-19 Treatment Panel guidelines that recommend its use.2

(…)

Keywords: SARS-CoV-2; COVID-19; Corticosteroids.

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#Dexamethasone in Hospitalized Patients with #Covid19 — Preliminary Report (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

List of authors.The RECOVERY Collaborative Group*

 

Abstract

BACKGROUND

Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death.

METHODS

In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison.

RESULTS

A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55).

CONCLUSIONS

In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936. opens in new tab; ISRCTN number, 50189673. opens in new tab.)

Keywords: SARS-CoV-2; COVID-19; Corticosteroids; UK.

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Early use of #tocilizumab in the #prevention of adult #respiratory #failure in #SARS‐CoV‐2 infections and the utilization of #IL6 levels in the management (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Early use of tocilizumab in the prevention of adult respiratory failure in SARS‐CoV‐2 infections and the utilization of interleukin‐6 levels in the management

Suresh J Antony,  Michelle A Davis,  Monique G Davis,  Nouf K Almaghlouth,  Roberto Guevara,  Fahad Omar,  Fernando Del Rey,  Ali Hassan,  Muhammad U Arian,  Nishaal Antony,  Bharat V Prakash

First published: 09 July 2020 | DOI:  https://doi.org/10.1002/jmv.26288

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26288

 

ABSTRACT

Background

Respiratory failure in severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection appears related to cytokine release syndrome (CRS) that often results in mechanical ventilation (MV). We investigated the role of tocilizumab (TCZ) on interleukin‐6 (IL‐6) trends and MV in SARS‐CoV‐2 patients.

Methods

In this longitudinal observational study, 112 patients were evaluated from 2/1/2020 ‐ 5/31/2020. TCZ was administered followed by methylprednisolone to patients with > 3L oxygen (O2) requirement and pneumonia severity index (PSI) score ≤ 130 with CT scan changes. IL‐6, C‐reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), D‐dimer, and procalcitonin were monitored on days 0, 3, and 6 of therapy. Statistical analyses were performed with significance ≤ 0.05.

Results

80/112 SARS‐CoV‐2‐positive patients (45 males, 56.96%; 34 females, 43.04%) were included in this study. Seven patients expired (8.75%) and nine patients required MV (11.25%). Median IL‐6 levels pre‐administration of TCZ was 342.50 (78.25 ‐ 666.25) pg/mL compared to post‐administration on day 3 (563; 162 ‐ 783) pg/mL (P < 0.00001). On day 6, the median dropped to 545 (333.50 ‐ 678.50) pg/mL compared to day 3 (P = 0.709). CRP, ferritin, LDH, and D‐dimer levels were reduced following TCZ therapy.

Conclusions

Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D‐dimer levels. The sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. IL‐6 levels may be helpful as a prognostic tool.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; Cytokines; Immunopathology; Tocilizumab; Corticosteroids.

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#Duration of #SARS‐CoV‐2 #RNA #shedding and #factors associated with prolonged viral shedding in patients with #COVID19 (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Duration of SARS‐CoV‐2 RNA shedding and factors associated with prolonged viral shedding in patients with COVID‐19

Tong‐Zeng Li,  Zhen‐Huan Cao,  Yu Chen,  Miao‐Tian Cai,  Long‐Yu Zhang,  Hui Xu, Jia‐Ying Zhang,  Chun‐Hua Ma,  Yang Liu,  Li‐Juan Gao,  Zhong‐Hui Duan,  Dan‐Lei Mou, Lian‐Chun Liang

First published: 09 July 2020 | DOI:  https://doi.org/10.1002/jmv.26280

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26280

 

ABSTRACT

Aim

To investigate the factors associated with the duration of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA shedding in patients with coronavirus disease 2019 (COVID‐19).

Methods

A retrospective cohort of COVID‐19 patients admitted to a designated hospital in Beijing was analyzed to study the factors affecting the duration of viral shedding.

Results

The median duration of viral shedding was 11 days (IQR, 8‐14.3 days) as measured from illness onset. Univariate regression analysis showed that disease severity, corticosteroid therapy, fever (temperature>38.5℃), and time from onset to hospitalization were associated with prolonged duration of viral shedding (p <0.05). Multivariate regression analysis showed that fever (temperature>38.5℃) (OR 5.1, 95%CI: 1.5‐18.1), corticosteroid therapy (OR 6.3, 95%CI: 1.5‐27.8), and time from onset to hospitalization (OR 1.8, 95%CI: 1.19‐2.7) were associated with increased odds of prolonged duration of viral shedding.

Conclusions

Corticosteroid treatment, fever (temperature>38.5℃), and longer time from onset to hospitalization were associated with prolonged viral shedding in COVID‐19 patients.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19.

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High-dose but not low-dose #corticosteroids potentially delay #viral #shedding of patients with #COVID19 (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases, full page: (LINK). Summary, edited.]

High-dose but not low-dose corticosteroids potentially delay viral shedding of patients with COVID-19

Sijia Li, Xinyu Song, Zhigang Hu

Downloaded from https://academic.oup.com/cid/article-abstract/doi/10.1093/cid/ciaa829/5863128 by guest on 26 June 2020

Accepted Manuscript

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases  Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

 

High-dose but not low-dose corticosteroids potentially delay viral shedding of patients with COVID-19

Sijia Li*1,2, Zhigang Hu# 1,2, Xinyu Song# 1,2

1. Department of Respiratory and Critical Care Medicine ,The first College of Clinical Medicine science, China Three Gorges University, Yichang 443003, People’s Republic of China; 2. Department of Respiratory and Critical Care Medicine, Yichang Central People’s  Hospital Yichang 443003, People’s Republic of China

# Zhigang Hu and Xinyu Song are listed as co-corresponding author.

Corresponding author: Zhigang Hu, MD Department of Respiratory medicine, the first  College of Clinical medicine science, Three Gorges University, NO. 183 Yiling Road,  Yichang 443003, People’s Republic of China. E-mail: hxq910813@163.com – Phone: 0717- 6486930 ORCID ID:https://orcid.org/0000-0003-3421-0674

Downloaded from https://academic.oup.com/cid/article-abstract/doi/10.1093/cid/ciaa829/5863128 by guest on 26 June 2020

Accepted Manuscript

___

Dear Editors: Considering cytokine storm secondary to SAR-Cov-2 infection, some  patients with COVID-19 received the treatment of systemic corticosteroids, especially  severe and critical patients. Systemic corticosteroid (methylprednisolone, <1-2 mg/kg, 3-5   days) is recommended as adjuvant therapy of COVID-19 in China [1]. We read with    interest the recent study by Xu et al [2] who determined risk factor associated with prolonged viral shedding in patients with COVID-19. They reported that use of corticosteroids was associated with higher probability of late viral RNA clearance (≥15  days after illness onset) in unvariate logistic regression analysis (P = 0.025), but not  shown in multivariate logistic regression analysis (OR= 1.38, 95%CI: 0.53, 3.65, P = 0.519).

(…)

Keywords: SARS-CoV-2; COVID-19; Cytokines; Corticosteroids.

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Effect of #Dexamethasone in Hospitalized Patients with #COVID19 – Preliminary #Report (Medrxiv, abstract)

[Source: MedRxiv, full page: (LINK). Abstract, edited, via BMJ.]

Effect of Dexamethasone in Hospitalized Patients with COVID-19 – Preliminary Report

Running title: Dexamethasone for COVID-19 – Preliminary Report

RECOVERY Collaborative Group*

*The writing committee and trial steering committee are listed at the end of this  manuscript and a complete list of collaborators in the Randomised Evaluation of COVID- 19 Therapy (RECOVERY) trial is provided in the Supplementary Appendix.

Correspondence to: Dr Peter W Horby and Dr Martin J Landray, RECOVERY Central  Coordinating Office, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford  OX3 7LF, United Kingdom. Email: recoverytrial@ndph.ox.ac.uk

Word count:

Abstract – 250 words; Main text – 2820; References – 40; Tables & Figures – 2 + 2

It is made available under a CC-BY 4.0 International license . (which was not certified by  peer review) is the author/funder, who has granted medRxiv a license to display the  preprint in perpetuity.

medRxiv preprint doi: https://doi.org/10.1101/2020.06.22.20137273.

this version posted June 22, 2020.  The copyright holder for this preprint

 

Dexamethasone for COVID-19 – Preliminary Report

ABSTRACT

Background:

Coronavirus disease 2019 (COVID-19) is associated with diffuse lung damage. Corticosteroids may modulate immune-mediated lung injury and reducing progression  to respiratory failure and death.

Methods:

The Randomised Evaluation of COVID-19 therapy (RECOVERY) trial is a randomized,  controlled, open-label, adaptive, platform trial comparing a range of possible treatments  with usual care in patients hospitalized with COVID-19. We report the preliminary results for the comparison of dexamethasone 6 mg given once daily for up to ten days vs.  usual care alone. The primary outcome was 28-day mortality.

Results:

2104 patients randomly allocated to receive dexamethasone were compared with 4321  patients concurrently allocated to usual care. Overall, 454 (21.6%) patients allocated dexamethasone and 1065 (24.6%) patients allocated usual care died within 28 days  (ageadjusted rate ratio [RR] 0.83; 95% confidence interval [CI] 0.74 to 0.92; P<0.001). The proportional and absolute mortality rate reductions varied significantly depending on  level of respiratory support at randomization (test for trend p<0.001): Dexamethasone  reduced deaths by one-third in patients receiving invasive mechanical ventilation (29.0%  vs. 40.7%, RR 0.65 [95% CI 0.51 to 0.82]; p<0.001), by one-fifth in patients receiving  oxygen without invasive mechanical ventilation (21.5% vs. 25.0%, RR 0.80  [95% CI 0.70 to 0.92]; p=0.002), but did not reduce mortality in patients not receiving  respiratory support at randomization (17.0% vs. 13.2%, RR 1.22 [95% CI 0.93 to 1.61];  p=0.14).

Conclusions:

In patients hospitalized with COVID-19, dexamethasone reduced 28-day  mortality among  those receiving invasive mechanical ventilation or oxygen at randomization, but  not among patients not receiving respiratory support.

Trial registrations: The RECOVERY trial is registered with ISRCTN (50189673) and clinicaltrials.gov (NCT04381936).

Funding: Medical Research Council and National Institute for Health Research (Grant  ref: MC_PC_19056).

Keywords: COVID-19, dexamethasone, clinical trial.

Keywords: SARS-CoV-2; COVID-19; Intensive Care; Corticosteroids.

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IMPACT OF #GLUCOCORTICOID #TREATMENT IN #SARS-COV-2 INFECTION #MORTALITY: A RETROSPECTIVE CONTROLLED COHORT STUDY (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

IMPACT OF GLUCOCORTICOID TREATMENT IN SARS-COV-2 INFECTION MORTALITY: A RETROSPECTIVE CONTROLLED COHORT STUDY

Ana Fernández Cruz [MD, PhD], Belén Ruiz-Antorán [MD, PhD], Ana Muñoz Gómez [MD], Aránzazu Sancho López [MD, PhD], Patricia Mills Sánchez [MD], Gustavo Adolfo Centeno Soto [MD, PhD], Silvia Blanco Alonso [MD], Laura Javaloyes Garachana [MD], Amy Galán Gómez [MD], Ángela Valencia Alijo [MD], Javier Gómez Irusta [MD], Concepción Payares-Herrera [MD, PhD], Ignacio Morrás Torre [MD], Enrique Sánchez Chica [MD], Laura Delgado Téllez de Cepeda [Pharm D, PhD], Alejandro Callejas Díaz [MD, PhD], Antonio Ramos Martínez [MD, PhD], Elena Múñez Rubio [MD, PhD], Cristina Avendaño-Solá [MD, PhD]; on behalf of Puerta de Hierro COVID-19 Study Group

DOI: 10.1128/AAC.01168-20

 

ABSTRACT

Background:

Evidence to support the use of steroids in COVID-19 pneumonia is lacking. We aim to determine the impact of steroid use in COVID-19 pneumonia in-hospital mortality.

Patients and Methods:

We performed a single-center retrospective cohort study in a University hospital in Madrid, Spain, during March 2020. To determine the role of steroids in in-hospital mortality, patients admitted with SARS-CoV-2 pneumonia and treated with steroids were compared to patients not treated with steroids, adjusting by a propensity-score for steroid treatment. Survival times were compared using log-rank test. Different steroid regimens were compared, and adjusted with a second propensity score.

Results:

During the study period, 463 out of 848 hospitalized patients with COVID19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) patients were treated with steroids and 67 patients were not. Global mortality was 15.1%. Median time to steroid treatment from symptom onset was 10 days (IQR 8-13). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67], HR 0.51 [0.27-0.96], p= 0.044). Steroid treatment reduced mortality by 41.8% relative to no steroid treatment (RRR 0,42 [0.048- 0.65). Initial treatment with 1 mg/kg/day of methylprednisolone versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86], OR 0.880 [0.449-1.726], p=0.710).

Conclusions:

Our results show that survival of patients with SARS-CoV2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. In-hospital mortality was not different between initial regimens of 1 mg/kg/day of methylprednisolone and glucocorticoid pulses.

Copyright © 2020 Fernández Cruz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

Keywords: SARS-CoV-2; COVID-19; Corticosteroids.

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Can #steroids reverse the severe #COVID19 induced #cytokine #storm? (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Can steroids reverse the severe COVID‐19 induced ‘cytokine storm’?

Lykourgos Kolilekas,  Konstantinos Loverdos,  Styliani Giannakaki,  Lamprini Vlassi, Anastasia Levounets,  Eleftherios Zervas,  Mina Gaga

First published: 12 June 2020 | DOI:  https://doi.org/10.1002/jmv.26165

Funding: None

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26165

 

Abstract

Severe COVID‐19 is characterized by an excessive pro‐inflammatory cytokine storm, resulting in acute lung injury and development of ARDS. The role of corticosteroids is controversial in severe COVID‐19 pneumonia and associated hyper‐inflammatory syndrome. We reported a case series of six consecutive COVID‐19 patients with severe pneumonia, ARDS and laboratory indices of hyper‐inflammatory syndrome. All patients were treated early with a short course of corticosteroids, and clinical outcomes were compared before and after corticosteroids administration. All patients evaded intubation and intensive care admission, ARDS resolved within 11.8 days (median), viral clearance was achieved in 4 patients within 17.2 days (median), and all patients were discharged from the hospital in 16.8 days (median). Early administration of short course corticosteroids improves clinical outcome of patients with severe COVID‐19 pneumonia and evidence of immune hyper‐reactivity.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; ARDS; Cytokines; Corticosteroids.

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#Glucocorticoid #therapy delays the #clearance of #SARS‐CoV‐2 #RNA in an #asymptomatic #COVID19 patient (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Glucocorticoid therapy delays the clearance of SARS‐CoV‐2 RNA in an asymptomatic COVID‐19 patient

Shu‐Qing Ma,  Jing Zhang,  Yu‐Shan Wang,  Jun Xia,  Peng Liu,  Hong Luo,  Ming‐Yi Wang

First published: 29 May 2020 | DOI:  https://doi.org/10.1002/jmv.26086

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26086

 

Abstract

The outbreak of severe acute respiratory syndrome‐related coronavirus 2 (SARS‐CoV‐2) started in Wuhan China, has become a global health concern. At present, glucocorticoid therapy is one of the most typically controversial treatments with COVID‐19 patients. Here, we reported an asymptomatic COVID‐19 patient with persistent positive detection of SARS‐CoV‐2 for 3 weeks and proposed that glucocorticoid therapy delays the clearance of SARS‐CoV‐2 RNA. Therefore, more attention must be paid to the COVID‐19 patients receiving glucocorticoid therapy.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; Corticosteroids.

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