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Antiviral-corticosteroid combo shows potential against COVID-19

Tristan Manalac
04 Dec 2020

The risk of clinical progression, invasive mechanical ventilation, and death among patients with the novel coronavirus disease (COVID-19) may be attenuated by a combination treatment of corticosteroids and antivirals, according to a recent Singapore study.

“The use of prednisolone during early pneumonia in our study [led to] a significantly better outcome, which may be due to the concurrent administration of antiviral agents such as hydroxychloroquine (HCQ) or lopinavir/ritonavir,” the researchers said.

Ninety-four adults with COVID-19 participated in the current retrospective analysis. Fifty-seven received antiviral therapy alone, while the remaining 35 were given adjunctive prednisolone. COVID-19 was confirmed through nasopharyngeal swabs subjected to polymerase chain reaction. All patients received care at the Khoo Tech Puat Hospital in Singapore.

Forty-four patients presented with pneumonia, of whom 68.9 percent did not require supplemental oxygen. At baseline, more patients assigned to receive add-on prednisolone had pneumonia, needed supplemental oxygen, and were on antibiotics. [Open Forum Infect Dis 2020;7:ofaa486]

Seventeen patients eventually saw clinical progression of COVID-19, corresponding to a rate of 18.5 percent relative to the overall sample. This occurred nominally more frequently among patients not on prednisolone, though the difference fell short of significance (22.8 percent vs 11.4 percent; p=0.172). Similarly, the need for invasive ventilation was slightly lower in the prednisolone group.

In terms of survival, one patient in the monotherapy arm died after mechanical ventilation; no such incident was reported in the prednisolone-treated group.

Moreover, levels of C-reactive protein (CRP) dropped following the initiation of prednisolone treatment. In patients treated with antivirals alone, CRP trended upwards 5–8 days after initiation before declining.

Prednisolone showed even greater value in the subsample of patients with pneumonia. Unweighted Kaplan-Meier estimates showed significant suppression of disease progression (58.8 percent vs 11.1 percent; p<0.001) and mechanical ventilation (41.2 percent vs 11.3 percent; p=0.016) among those on adjunctive corticosteroid.

Weighted Cox regression analysis confirmed that prednisolone had a significant protective effect against disease progression both in overall sample (hazard ratio [HR], 0.08, 95 percent confidence interval [CI], 0.01–0.99; p=0.049) and in patients with pneumonia (HR, 0.15, 95 percent CI, 0.06–0.39; p<0.001).

While the findings suggest the potential of corticosteroids against COVID-19, there remains cause for caution, according to the researchers.

“The prominent protective effect of adjunctive prednisolone observed in our cohort with early pneumonia and the varying effect of dexamethasone on different days of illness of COVID-19 in the RECOVERY trial call for different treatment strategies at different clinical stages of COVID-19,” the researchers said.

“Further prospective studies should be considered to evaluate the clinical efficacy of combination treatment in early COVID-19 pneumonia,” they added.

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Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Jairia Dela Cruz, 3 days ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.
3 days ago
Use of thyroid hormone therapy does not seem to protect older adults with subclinical hypothyroidism against mortality, but it appears to confer survival benefits to those aged <65 years, results of a study have shown.