Journal Article

Early Use of Corticosteroid May Prolong SARS-CoV-2 Shedding in Non-Intensive Care Unit Patients with COVID-19 Pneumonia: A Multicenter, Single-Blind, Randomized Control Trial

Xie, Jiao, Wu, Xiu-Zhi, Wang, Wen, Chen, Jun-Wen, Zhang, Jia-Ying, Li, Yu-Lei, Feng, Ying-Mei, Su, Jian, Tang, Xiao, Zhang, Ji-Xian, Zhao, Yang, Zhang, Jian-Chu, Shi, Huan-Zhong, Ni, Ji-Xiang, Hu, Ke, Jin, Rong-Hua, He, Xin-Liang, Liu, Li-Min, Sun, Bing, Ding, Zhou

2021

Overview

Background: There is still no clinical evidence available to support or to oppose corticosteroid treatment for coronavirus disease 2019 (COVID-19) pneumonia. Objective: To investigate the efficacy and safety of corticosteroid given to the hospitalized patients with COVID-19 pneumonia. Methods: This was a prospective, multicenter, single-blind, randomized control trial. Adult patients with COVID-19 pneumonia who were admitted to the general ward were randomly assigned to either receive methylprednisolone or not for 7 days. The primary end point was the incidence of clinical deterioration 14 days after randomization. Results: We terminated this trial early because the number of patients with COVID-19 pneumonia in all the centers decreased in late March. Finally, a total of 86 COVID-19 patients underwent randomization. There was no difference of the incidence of clinical deterioration between the methylprednisolone group and control group (4.8 vs. 4.8%, p = 1.000). The duration of throat viral RNA detectability in the methylprednisolone group was 11 days (interquartile range, 6–16 days), which was significantly longer than that in the control group (8 days [2–12 days], p = 0.030). There were no significant differences between the 2 groups in other secondary outcomes. Mass cytometry discovered CD3 + T cells, CD8 + T cells, and NK cells in the methylprednisolone group which were significantly lower than those in the control group after randomization (p < 0.05). Conclusions: From this prematurely closed trial, we found that the short-term early use of corticosteroid could suppress the immune cells, which may prolong severe acute respiratory syndrome coronavirus 2 shedding in patients with COVID-19 pneumonia. Trial Registration: ClinicalTrials.gov, NCT04273321.

• Publisher: S. Karger AG
• Subject: Adult / Aged / Anti-Bacterial Agents - therapeutic use / Antiviral Agents - therapeutic use / Bacterial pneumonia / Causes of / CD3 Complex / CD8-Positive T-Lymphocytes / Clinical Investigations / COVID-19 - blood / COVID-19 - drug therapy / COVID-19 - therapy / COVID-19 - transmission / COVID-19 Nucleic Acid Testing / Disease Progression / Dosage and administration / Drug therapy / Early Medical Intervention / Extracorporeal Membrane Oxygenation / Female / Glucocorticoids - therapeutic use / Hospitalization / Humans / Killer Cells, Natural / Lymphocyte Count / Male / Methylprednisolone / Methylprednisolone - therapeutic use / Middle Aged / Oxygen Inhalation Therapy / Patients' Rooms / Pharynx - chemistry / Pharynx - virology / Pneumonia / Proportional Hazards Models / Respiration, Artificial / RNA, Viral - isolation & purification / SARS-CoV-2 / Single-Blind Method / T-Lymphocyte Subsets / T-Lymphocytes / Testing / Time Factors / Treatment Outcome / Virus Shedding