Clinical efficacy of various regimens of systemic glucocorticoids therapy in COVID-19 patients

Abstract

Introduction. Systemic glucocorticoids have been successfully used in the treatment of patients with moderate to severe COVID-19. However, the best clinical efficacy dosage regimen and duration of glucocorticoid usage is remained unclear.Aim. To evaluate the results of using different regimens of systemic glucocorticoid therapy in the treatment of patients with moderate and severe COVID-19.Materials and methods. The results of a retrospective study of medical papers of 200 patients who had moderate to severe COVID-19 in the period from May 2020 to December 2021 are presented. The inclusion criterion was the use different regimens of doses and durations systemic glucocorticoid therapy in these patients without the use blockers of Janus kinases. and genetically engineered biological drugs. Clinical effectiveness was assessed by the severity and sufficiency of the anti-inflammatory effect, the frequency and nature of side effects of this therapy.Results. The regimen of glucocorticoids at a dose equivalent to 6 mg/day of dexamethasone for 7 days demonstrated the greatest clinical effectiveness: it significantly reduced C-reactive protein, hematological inflammatory indices,% lung tissue damage, minimally affecting carbohydrate metabolism and hemostasis. Glucocorticoid therapy equivalent to 20 mg/day of dexamethasone for more than 7 days and pulse-therapy for 3 days demonstrated significantly lower clinical effectiveness.Conclusions. In patients with moderate to severe COVID-19, it is reasonable to use a dose of glucocorticoid equivalent to 6 mg/day of dexamethasone for 7 to 10 days, or equivalent to 20 mg/day for no more than 7 days. The use of pulse therapy and the use of glucocorticoids at a dose equivalent to ≥ 20 mg/day of dexamethasone for a duration of 7 days are not recommended. To assess the dynamics of inflammation and monitor the effectiveness of glucorticoid therapy, in addition to routine markers of inflammation, it is recommended to use hematological inflammatory indices.