Timing methylprednisolone pulse therapy in COVID-19 infection-finding the sweet spot: a case series

Authors

  • Anupam Kumar Department of Internal Medicine and Endocrinology, Command Hospital (SC), Pune, Maharashtra, India
  • Suhail Singh Department of Internal Medicine, Command Hospital (SC), Pune, Maharashtra, India
  • Vikas Sherawat Department of Internal Medicine, Command Hospital (SC), Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20214138

Keywords:

Corticosteroid, COVID-19, Methyl prednisolone, SARS-CoV-2

Abstract

Steroid therapy has been proven beneficial in the treatment of SARS-CoV2 in various trials all around the world. However, the dosing and timing of this therapy are crucial and still under debate. Studies exist regarding the use of Pulse IV therapy of steroids in this illness, but it has still not been widely used and accepted throughout the world. Here we describe four cases of SARS-CoV2 who presented to a tertiary care center in India within the first week of illness, with moderate to severe disease activity. These patients were treated with Pulse doses of intravenous MethylPrednisolone. All four patients showed positive outcomes in terms of oxygen requirement and early recovery.

References

Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924.

Pal M, Berhanu G, Desalegn C, Kandi V. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2): an update. Cureus. 2020;12(3):7423.

Guarner J. Three emerging coronaviruses in two decades. Am J Clin Pathol. 2020;153(4):420-1.

Cano EJ, Fuentes XF, Campioli C, O'Horo JC, Saleh OA, Odeyemi Y, et al. Impact of corticosteroids in coronavirus disease 2019 outcomes: systematic review and meta-analysis. Chest. 2021;159(3):1019-40.

Mishra GP, Mulani J. Corticosteroids for COVID-19: the search for an optimum duration of therapy. Lancet Respir Med. 2021;9(1):8.

ASHP COVID-19 Resource Center. Fact sheet: Assessment of evidence for COVID-19-related treatments. Available at: https://www.ashp.org/-/media/8CA43C674C6D4335B6A19852843C4052.ashx. Accessed on 2 September 2021.

Suran K, Pushpa S. Pulse therapy-a newer approach. Indian J Multidiscip Dent. 2017;7(1):41-4.

WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne JAC, Murthy S, Diaz JV, Slutsky AS, Villar J, et al. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis. JAMA. 2020;324(13):1330-41.

Jirjees F, Saad AK, AlHano Z, Hatahet T, AlObaidi H, Bashi YHD. COVID-19 treatment guidelines: do they really reflect best medical practices to manage the pandemic? Infect Dis Rep. 2021;13(2):259-84.

Yong KL, Chng CL, Htoon HM, Lim LH, Seah LL. Safety profile and effects of pulsed methylprednisolone on vital signs in thyroid eye disease. Int J Endocrinol. 2015;2015:457123.

Edalatifard M, Akhtari M, Salehi M, Naderi Z, Jamshidi A, Mostafaei S, et al. Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomised controlled clinical trial. Eur Respir J. 2020;56(6):2002808.

Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020;39(5):405-7.

Shah VK, Firmal P, Alam A, Ganguly D, Chattopadhyay S. Overview of immune response during SARS-CoV-2 infection: lessons from the past. Front Immunol. 2020;11:1949.

Rowaiye AB, Okpalefe OA, Adejoke O, Ogidigo JO, Oladipo OH, Ogu AC, et al. Attenuating the effects of novel COVID-19 (SARS-CoV-2) infection-induced cytokine storm and the implications. J Inflamm Res. 2021;14:1487-510.

Mahase E. COVID-19: low dose steroid cuts death in ventilated patients by one-third, trial finds. BMJ. 2020;369:2422.

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Published

2021-10-26

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Section

Case Series