Effects of Pulse Dose of Corticosteroids in Hospitalized Patients with COVID-19: An Observational Study

Hadis Nikpour; Fatemeh Heydarpour; Siavash Vaziri; Mohammad Hossein Zamanian; Foroud Shahbazi

doi:10.18502/jpc.v10i1.9125

Hadis Nikpour Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Fatemeh Heydarpour Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Siavash Vaziri Department of Infectious Disease, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Mohammad Hossein Zamanian Department of Infectious Disease, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Foroud Shahbazi Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran.

DOI: https://doi.org/10.18502/jpc.v10i1.9125

Keywords: Drug Therapeutic Index; Corticosteroids; COVID-19

Abstract

Background: Although corticosteroids are commonly used for COVID-19 disease during the inflammatory phase, the effective doses and the best choice of corticosteroids are not yet known.

Methods: In the present study, the effects of non-pulse (30-250 mg/day of prednisolone equivalent) versus pulse equivalent (>250 mg/day of prednisolone equivalent) doses of corticosteroids are compared in terms of the patients’ oxygen saturation, hospital mortality, and side effects. In addition, the patients were followed for 2 months for readmission and mortality.

Results: 270 severe or critically ill patients with COVID-19 disease were included in the study. Diabetes and hypertension were the most common comorbidities. More than 80% of the patients received corticosteroids. Pulse equivalent doses of corticosteroids were used in 36.9 % of the patients. Treatment with pulse doses of corticosteroid significantly increased the oxygen saturation in the critically ill patients. However, the pulse doses significantly increased the in-hospital mortality rate [29 (20.3%) vs. 12 (10.6%), p=0.036] and the side effects. In addition, a trend toward higher 60-day mortality was observed in the pulse-based-treated patients [31 (21.7%) vs. 14 (12.4%), p=0.053]. The multivariate analysis showed that having comorbidities increased the mortality risk independently [OR 3.33, CI 1.148-9.647].

Conclusion: The results showed that the pulse doses of corticosteroids increase the oxygen saturation, but they also can increase mortality. Further randomized controlled trials with larger sample sizes are needed to confirm our findings.