Early Stage Combination Treatment with Methylprednisolone Pulse and Remdesivir for Severe COVID-19 Pneumonia.
COVID-19
corticosteroids
pulse therapy
remdesivir
Journal
International journal of environmental research and public health
ISSN: 1660-4601
Titre abrégé: Int J Environ Res Public Health
Pays: Switzerland
ID NLM: 101238455
Informations de publication
Date de publication:
07 01 2023
07 01 2023
Historique:
received:
16
11
2022
revised:
04
01
2023
accepted:
05
01
2023
entrez:
21
1
2023
pubmed:
22
1
2023
medline:
25
1
2023
Statut:
epublish
Résumé
This study evaluated the clinical outcomes of patients with severe COVID-19 pneumonia treated with remdesivir plus standard corticosteroid treatment (SCT) or with remdesivir plus high-dose corticosteroid pulse therapy (HDCPT). One hundred and two patients with severe COVID-19 pneumonia and respiratory failure were included. The patients were divided into two cohorts. The first comprised patients who received remdesivir and SCT, consisting of 6 mg dexamethasone daily for up to 10 days or until hospital discharge. The second included patients who received remdesivir and HDCPT, composed of 250 mg iv of methylprednisolone for three days, followed by a slow reduction in the dose of steroids. The severity of hypoxemia was assessed using the SaO2/FiO2 peripheral oxygen saturation index. 55 received remdesivir plus HDCPT, and 47 received remdesivir plus SCT. Mortality at 30 days was significantly lower among patients who received remdesivir plus HDCPT (4/55) than among those who did not (15/47). In patients who received remdesivir plus HDCPT, 7.3% required invasive mechanical ventilation and admission to the ICU and 36.4% non-invasive ventilation versus 29.8% and 61.7%, respectively, among those treated with remdesivir plus SCT. Remdesivir plus HDCPT induced a significantly faster improvement in the SaO2/FiO2 index. Early combination treatment with remdesivir plus HDCPT reduced in-hospital mortality and the need for admission to the ICU. Furthermore, it improved the SaO2/FiO2 index faster in patients with severe COVID-19 pneumonia.
Sections du résumé
BACKGROUND
This study evaluated the clinical outcomes of patients with severe COVID-19 pneumonia treated with remdesivir plus standard corticosteroid treatment (SCT) or with remdesivir plus high-dose corticosteroid pulse therapy (HDCPT).
METHODS
One hundred and two patients with severe COVID-19 pneumonia and respiratory failure were included. The patients were divided into two cohorts. The first comprised patients who received remdesivir and SCT, consisting of 6 mg dexamethasone daily for up to 10 days or until hospital discharge. The second included patients who received remdesivir and HDCPT, composed of 250 mg iv of methylprednisolone for three days, followed by a slow reduction in the dose of steroids. The severity of hypoxemia was assessed using the SaO2/FiO2 peripheral oxygen saturation index.
RESULTS
55 received remdesivir plus HDCPT, and 47 received remdesivir plus SCT. Mortality at 30 days was significantly lower among patients who received remdesivir plus HDCPT (4/55) than among those who did not (15/47). In patients who received remdesivir plus HDCPT, 7.3% required invasive mechanical ventilation and admission to the ICU and 36.4% non-invasive ventilation versus 29.8% and 61.7%, respectively, among those treated with remdesivir plus SCT. Remdesivir plus HDCPT induced a significantly faster improvement in the SaO2/FiO2 index.
CONCLUSION
Early combination treatment with remdesivir plus HDCPT reduced in-hospital mortality and the need for admission to the ICU. Furthermore, it improved the SaO2/FiO2 index faster in patients with severe COVID-19 pneumonia.
Identifiants
pubmed: 36673839
pii: ijerph20021081
doi: 10.3390/ijerph20021081
pmc: PMC9859517
pii:
doi:
Substances chimiques
Methylprednisolone
X4W7ZR7023
remdesivir
3QKI37EEHE
Alanine
OF5P57N2ZX
Adrenal Cortex Hormones
0
Oxygen
S88TT14065
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Références
Chest. 2015 Dec;148(6):1477-1483
pubmed: 26271028
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
Chest. 2007 Aug;132(2):410-7
pubmed: 17573487
Lancet Respir Med. 2020 Apr;8(4):420-422
pubmed: 32085846
Mediators Inflamm. 2021 Mar 12;2021:6637227
pubmed: 33776574
PLoS One. 2022 Feb 17;17(2):e0262564
pubmed: 35176057
JAMA. 2020 Oct 6;324(13):1307-1316
pubmed: 32876695
Eur Respir Rev. 2020 Oct 5;29(157):
pubmed: 33020069
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
J Antimicrob Chemother. 2021 Jul 15;76(8):1962-1968
pubmed: 33758946
Multidiscip Respir Med. 2021 Jun 30;16(1):781
pubmed: 34322232
Monaldi Arch Chest Dis. 2021 Jul 19;91(4):
pubmed: 34284567
Respirol Case Rep. 2020 Jun 04;8(6):e00596
pubmed: 32514354
Infect Dis Ther. 2021 Dec;10(4):2447-2463
pubmed: 34389970
Eur J Clin Invest. 2021 Feb;51(2):e13458
pubmed: 33219551
Nat Clin Pract Rheumatol. 2008 Oct;4(10):525-33
pubmed: 18762788
PLoS One. 2021 Jan 28;16(1):e0243964
pubmed: 33507958
Clin Infect Dis. 2021 Dec 6;73(11):e4166-e4174
pubmed: 32706859
J Med Virol. 2023 Jan;95(1):e28168
pubmed: 36148941
Clin Pharmacol Ther. 2021 Jun;109(6):1660-1667
pubmed: 33792037
PLoS One. 2022 Apr 28;17(4):e0267038
pubmed: 35482703
JAMA. 2020 Oct 6;324(13):1330-1341
pubmed: 32876694
Trends Pharmacol Sci. 2019 Jan;40(1):38-49
pubmed: 30497693
Chest. 2017 Dec;152(6):1151-1158
pubmed: 28823812
Eur Respir J. 2020 Dec 24;56(6):
pubmed: 32943404