Early treatment with glucocorticoids may be beneficial for patients hospitalized with coronavirus disease 2019 (COVID-19) who have high levels of inflammation due to the disease, according to the findings of a study recently published in the Journal of Hospital Medicine.

The observational study, which was led by the Albert Einstein College of Medicine and Montefiore Health System, aimed to assess the effect of glucocorticoid therapy on mortality and the need for mechanical ventilation in hospitalized patients with COVID-19 (N=1806). Of the total patients, 140 (7.7%) received glucocorticoids within 48 hours of admission and 1666 patients did not receive steroid therapy (control group). The majority of patients in the treatment group received prednisone, while some received dexamethasone or methylprednisolone. 

The study authors reported that early glucocorticoid treatment was not found to be associated with either mortality or mechanical ventilation. Findings of the study did reveal that treatment with glucocorticoids in patients with an initial C-reactive protein (CRP) level of ≥20mg/dL significantly reduced the risk of mortality or mechanical ventilation (odds ratio [OR], 0.23; 95% CI, 0.08-0.70), however in those with an initial CRP level of <10mg/dL, glucocorticoid therapy was found to significantly increase the risk of mortality or mechanical ventilation (OR, 2.64; 95% CI, 1.39-5.03). The results of this study were found to apply to all patients regardless of gender, race, or ethnicity.  

The findings of this study also reaffirmed results obtained from the Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial, a large-scale study recently conducted in the United Kingdom. Preliminary analysis of the open-label RECOVERY trial showed that treatment with dexamethasone was associated with reduced mortality rates in hospitalized COVID-19 patients.

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“Our study extends the findings of the RECOVERY trial in 2 important ways,” the study authors stated. “First, in addition to finding some patients who may benefit, we also have identified patient groups that may experience harm from treatment with glucocorticoids. Second, we have identified patient groups who are likely to benefit (or be harmed) on the basis of a widely available lab test (CRP).” The authors acknowledged that additional studies were needed to further understand the role of CRP in guiding treatment with glucocorticoids in COVID-19 patients.

References:

  1. Keller MJ, Kitsis EA, Arora S, et al. Effect of Systemic Glucocorticoids on Mortality or Mechanical Ventilation in Patients With COVID-19 [published online July 22, 2020]. Journal of Hospital Medicine. doi: 10.12788/jhm.3497.
  2. Common blood test identifies benefits and risks of steroid treatment in COVID-19 patients. https://www.eurekalert.org/pub_releases/2020-07/aeco-cbt071720.php. Published July 22, 2020. Accessed July 23, 2020.