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

Respiration - Tập 100 Số 2 - Trang 116-126 - 2021
Xiao Tang1, Yingmei Feng2, Jingen Ni3, Jia-Ying Zhang2, Luzhen Liu4, Ke Hu5, Xiu-Zhi Wu1, Ji-Xian Zhang6, Jun Wen Chen7, Jian-Chu Zhang8, Su Jian3, Yu Lei Li4, Yang Zhao5, Jiao Xie6, Zhou Ding7, Xin-Liang He8, Wen Wang1, Jin Rong2, Huan‐Zhong Shi1, Bing Sun1
1Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
2Beijing You-an Hospital, Capital Medical University, Beijing, China
3Department of Respiratory and Critical Care Medicine, Yi-Chang First People's Hospital, The People's Hospital of China Three Gorges University, Hubei Province, China
4Department of Respiratory and Critical Care Medicine, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, China
5Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
6Department of Respiratory and Critical Care Medicine, Hubei Province Hospital of Integrated Chinese & Western Medicine, Wuhan, China
7Department of Respiratory and Critical Care Medicine, Xiang-Yang First people's Hospital, Hubei Province, China
8Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Huazhong, China

Tóm tắt

<b><i>Background:</i></b> There is still no clinical evidence available to support or to oppose corticosteroid treatment for coronavirus disease 2019 (COVID-19) pneumonia. <b><i>Objective:</i></b> To investigate the efficacy and safety of corticosteroid given to the hospitalized patients with COVID-19 pneumonia. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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%, <i>p</i> = 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], <i>p</i> = 0.030). There were no significant differences between the 2 groups in other secondary outcomes. Mass cytometry discovered CD3<sup>+</sup> T cells, CD8<sup>+</sup> T cells, and NK cells in the methylprednisolone group which were significantly lower than those in the control group after randomization (<i>p</i> &#x3c; 0.05). <b><i>Conclusions:</i></b> 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. <b><i>Trial Registration:</i></b> ClinicalTrials.gov, NCT04273321.

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Respiration

Tập 100 Số 2

116-126

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