Open AccessModerate bis schwere SARS-CoV-2-Infektion: Patienten können von niedrig dosierten Kortikosteroiden profitieren
Author(s) -
Stefan Krüger
Publication year - 2022
Publication title -
karger kompass. pneumologie
Language(s) - English
Resource type - Journals
eISSN - 2296-0317
pISSN - 2296-0368
DOI - 10.1159/000521589
Subject(s) - medicine , lopinavir , prednisolone , hydroxychloroquine , azithromycin , regimen , ritonavir , lopinavir/ritonavir , population , intensive care unit , gastroenterology , surgery , viral load , covid-19 , immunology , human immunodeficiency virus (hiv) , antibiotics , disease , environmental health , antiretroviral therapy , infectious disease (medical specialty) , microbiology and biotechnology , biology
Background: We performed a multicenter, randomized open-label trial in patients with moderate to severe Covid-19 treated with a range of possible treatment regimens. Methods: Patients were randomly assigned to one of three regimen groups at a ratio of 1:1:1. The primary outcome of this study was admission to the intensive care unit. Secondary outcomes were intubation, in-hospital mortality, time to clinical recovery, and length of hospital stay (LOS). Between April 13 and August 9, 2020, a total of 336 patients were randomly assigned to receive one of the 3 treatment regimens including group I (hydroxychloroquine stat, prednisolone, azithromycin and naproxen; 120 patients), group II (hydroxychloroquine stat, azithromycin and naproxen; 116 patients), and group III (hydroxychloroquine and lopinavir/ritonavir (116 patients). The mean LOS in patients receiving prednisolone was 5.5 in the modified intention-to-treat (mITT) population and 4.4 days in the per-protocol (PP) population ompared with 6.4 days (mITT population) and 5.8 days (PP population) in patients treated with Lopinavir/Ritonavir. Results: The mean LOS was significantly lower in the mITT and PP populations who received prednisolone compared with populations treated with Lopinavir/Ritonavir (p = 0.028; p = 0.0007). We observed no significant differences in the number of deaths, ICU admission, and need for mechanical ventilation between the Modified ITT and per-protocol populations treated with prednisolone and Lopinavir/Ritonavir, although these outcomes were better in the arm treated with prednisolone. The time to clinical recovery was similar in the modified ITT and per-protocol populations treated with prednisolone, lopinavir/ritonavir, and azithromycin (p = 0.335; p = 0.055; p = 0.291; p = 0.098). Conclusions: The results of the present study show that therapeutic regimen (regimen I) with low dose prednisolone was superior to other regimens in shortening the length of hospital stay in patients with moderate to severe COVID-19. The steroid sparing effect may be utilized to increase the effectiveness of corticosteroids in the management of diabetic patients by decreasing the dosage.