Early Short Course Corticosteroids in Hospitalized Patients with COVID-19

Authors

Raef Fadel, Henry Ford HealthFollow
Austin R. Morrison, Henry Ford HealthFollow
Amit Vahia, Henry Ford HealthFollow
Zachary R. Smith, Henry Ford HealthFollow
Zohra Chaudhry, Henry Ford HealthFollow
Pallavi Bhargava, Henry Ford HealthFollow
Joseph B. Miller, Henry Ford HealthFollow
Rachel M. Kenney, Henry Ford HealthFollow
George Alangaden, Henry Ford HealthFollow
Mayur Ramesh, Henry Ford HealthFollow

Recommended Citation

Fadel R, Morrison AR, Vahia A, Smith ZR, Chaudhry Z, Bhargava P, Miller J, Kenney RM, Alangaden G, and Ramesh MS. Early Short Course Corticosteroids in Hospitalized Patients with COVID-19. Clin Infect Dis 2020.

Document Type

Article

Publication Date

5-19-2020

Publication Title

Clinical infectious diseases

Abstract

BACKGROUND: There is no proven antiviral or immunomodulatory therapy for COVID-19. The disease progression associated with the pro-inflammatory host response prompted us to examine the role of early corticosteroid therapy in patients with moderate to severe COVID-19.

METHODS: We conducted a single pre-test, single post-test quasi-experiment in a multi-center health system in Michigan from March 12 to March 27, 2020. Adult patients with confirmed moderate to severe COVID were included. A protocol was implemented on March 20, 2020 using early, short-course, methylprednisolone 0.5 to 1 mg/kg/day divided in 2 intravenous doses for 3 days. Outcomes of standard of care (SOC) and early corticosteroid groups were evaluated, with a primary composite endpoint of escalation of care from ward to ICU, new requirement for mechanical ventilation, and mortality. All patients had at least 14 days of follow-up.

RESULTS: We analyzed 213 eligible subjects, 81 (38%) and 132 (62%) in SOC and early corticosteroid groups, respectively.The composite endpoint occurred at a significantly lower rate in the early corticosteroid group (34.9% vs. 54.3%, p=0.005). This treatment effect was observed within each individual component of the composite endpoint. Significant reduction in median hospital length of stay was also observed in the early corticosteroid group (8 vs. 5 days, p < 0.001). Multivariate regression analysis demonstrated an independent reduction in the composite endpoint at 14-days controlling for other factors (aOR: 0.41; 95% CI [0.22 - 0.77]).

CONCLUSION: An early short course of methylprednisolone in patients with moderate to severe COVID-19 reduced escalation of care and improved clinical outcomes.

PubMed ID

32427279

ePublication

ePub ahead of print