Three coronavirus disease 2019 cases with acute progression of respiratory failure were improved after methylprednisolone therapy

Abstract

The main target of anti-inflammatory drug therapies for coronavirus disease 2019 (COVID-19) is reducing the risk of acute respiratory distress syndrome (ARDS), an important risk factor for acute death. In the RECOVERY trial, 6 mg/day of dexamethasone for up to 10 days improved 28-day mortality compared with those who received usual care alone. Here, we present three COVID-19 cases who improved after treatment with methylprednisolone (MPSL) and/or following prednisolone (PSL) for acute progression of respiratory failure. Three male COVID-19 patients, aged 56, 84, and 49 years old, developed acute respiratory failure after admission. MPSL therapy (500 mg/day for 3 days) was started for these patients at 4, 4, and, 2 days after admission, respectively, when oxygen administration was required. Following this therapy, two of the three present cases received 30 or 40 mg/day of PSL for an additional 6 and 8 days, respectively. The remaining case discontinued corticosteroid after MPSL therapy. All three cases survived, had fever reduction at 6, 2, and 1 days after start of MPSL therapy, could discontinue oxygen therapy at 6, 6, and 11 days after start of MPSL therapy, and showed negative results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction at 8, 6, and 22 days after start of MPSL therapy, respectively. No serious side effects due to drug discontinuation of treatment for COVID-19 were observed. MPSL is a candidate drug for corticosteroid therapy for COVID-19. Corticosteroid therapy should be started in the early stage of respiratory failure. Optimal drug selection, timing of intervention, dose, and duration of corticosteroid therapy for COVID-19 should be analyzed in the further studies. © Journal of Xiangya Medicine. All rights reserved.