Clinical Use of Short-Course and Low-Dose Corticosteroids in Patients With Non-severe COVID-19 During Pneumonia Progression

Background: The emerging coronavirus disease 2019 (COVID-19) has become a serious public health concern with a high number of fatalities It is unclear whether corticosteroids could be a candidate for an early intervention strategy for patients with COVID-19 Methods: In this retrospective cohort study, we analyzed data from 28 corticosteroid-treated patients with non-severe but advanced COVID-19, in which short-course and low-dose corticosteroids were administered because of unremitting or worsening clinical conditions during hospitalization To compare the effect of corticosteroids on viral clearance, 44 corticosteroid-untreated patients were included as controls Results: At the time of admission, corticosteroid-treated patients (n = 28) had a more advanced baseline illness compared with corticosteroid-untreated patients (n = 44), as reflected by poorer blood laboratory parameters (lymphocytes, C-reactive protein, and lactate dehydrogenase) and more extensive chest computed tomography (CT) abnormalities Corticosteroids were given because of radiological evidence of pneumonia progression (26/28) and/or unremitting fever (22/28) after admission The median time from illness onset to corticosteroid treatment was 9 days (IQR, 7-10) The median duration and accumulated dose of corticosteroid treatment were 4 5 days [interquartile range (IQR), 3-5] and 140 mg of methylprednisolone (IQR, 120-200) Intravenous immunoglobulin (20 g per day for 3-5 days) was co-administered with corticosteroids With the corticosteroid treatment, all patients achieved an abatement of fever within 1 day, and 78 6% (22/28) of the patients achieved radiological remission when evaluated about 3 days later Only one (3 6%) patient progressed to severe COVID-19, and all patients recovered and were discharged without any sequela The median time from illness onset to viral clearance was similar, as compared with 44 corticosteroid-untreated patients with relatively milder disease [18 (IQR 14 3-23 5) days vs 17 (IQR, 12-20) days, p = 0 252] When adjusted for age, sex, underlying comorbidities, baseline blood laboratory parameters, viral load, and chest radiological findings, the causal hazard ratio of corticosteroid treatment for the viral clearance was 0 79 (95%CI, 0 48-1 30, p = 0 34) Conclusion: Short-course and low-dose applications of corticosteroids, when co-administered with intravenous immunoglobulin, in non-severe COVID-19 patients during the stage of clinical deterioration may possibly prevent disease progression, while having a negligible impact on the viral clearance