Until November 11, , 52,, people are infected globally, with 1,, deaths, with the lethality of 2. In a retrospective multicenter study in Michigan, United States, the administration of hydroxychloroquine alone or in combination with azithromycin was associated with a reduction in mortality [ 8 ]. However, in randomized clinical trials, no favorable effect was evidenced.
In this study, mortality was lower in the patients who received dexamethasone in comparison with the group that did not receive it. However, it is not clear so far if the treatment for the complications of Covid, Acute Respiratory Distress Syndrome ARDS [ 10 ] or Cytokine Release Syndrome CRS [ 11 ], is a particular effect of dexamethasone or is a class effect in which other corticosteroids can be used, or even if the low or high doses of corticosteroids are similar in this effect.
After obtaining informed consent, patients were treated according to the institutional protocol from June 11 to September 14, with dexamethasone 6mg intravenous daily for up to 10 days or until hospital discharge if the patient required supplemental oxygen retrospective cohort. Since September 15, , the management protocol was changed from dexamethasone to methylprednisolone to mg daily for three days, followed by prednisone 50 mg orally every day for 14 days prospective cohort.
The median dose of methylprednisolone was mg intravenous day for three days. The dose was based on management reports in SARS-CoV and the experience of management of fulminant Pneumonia and organized Pneumonia in the institution.
All patients started treatment on the first day of hospitalization and were not randomly selected. As exclusion criteria to enter any cohort of the study, contraindications associated with corticosteroids were considered, dissent for medical management, death in the first 24 hours, patient in palliative care or with a life expectancy of less than six months.
If the patient required admission to the ICU and did not receive at least two doses of the corticosteroid, was withdrawn from the cohort to follow In the ICU protocol, only dexamethasone 6 mg is given intravenously. If the patient receives at least two doses of methylprednisolone but did not continue with prednisone, they were not included, but their outcome continued to be monitored.
Patients who also received less than two days of dexamethasone treatment were withdrawn from study follow-up. Colchicine was administered by clinic protocol since July 1; this variable was included in the patients evaluated.
Upon admission, laboratory tests were performed, such as hemogram, kidney, liver function tests, arterial blood gases, lactate dehydrogenase, D-dimer, serum ferritin, and C-reactive protein. Low molecular weight heparins were prescribed to all patients to prevent thromboembolism during their hospital stay. Pneumonia was classified as severe by the presence of hypoxemia or the need for supplemental oxygen, and in some cases, complicated with septic shock syndrome, or multisystem compromise.
The arterial blood gases results during each patient hospitalization were evaluated to determine the evolution of ARDS. The primary outcome is Recovery time, defined as significant clinical improvement in the evolution of the patient to consider discharge.
Thus, subjective improvement of dyspnea was required, reduction of oxygen support at least until oxygen was available through nasal cannula if previously on oxygen for ventury, non-rebreathing mask, non-invasive mechanical ventilation or invasive mechanical ventilation or supplementary oxygen removal. Secondary outcomes are transfer to intensive care unit ICU , mortality and readmission 30 days after discharge, hospital over infection.
Standardization was carried out in the observation of the researcher, thus guaranteeing adequate techniques in collecting information. With these data, a database was built in Microsoft Excel, and before the analysis, it was subjected to quality control. Comparing the methylprednisolone MTP vs. This analysis was carried out through a survival analysis model with Cox regression [ 12 ], and it was proved that the risks were proportional, from two stages: in the first, a robust Cox regression [ 13 ] was carried out to identify the predictor variables that explain the hazard ratio HR , avoiding a possible interference of outlier observations in the partial likelihood estimation.
These statistical analysis were performed in the R statistical software [ 14 ] through the coxrobust package [ 15 ] to perform the robust Cox regression and survival package [ 16 ] for traditional Cox regression. The Clinica Medellin ethics committee approved the study. Informed consent was obtained from the study participants. In total, patients were included, received dexamethasone retrospective DXM cohort , and patients received methylprednisolone prospective MTP cohort Fig 1.
There were no statistically significant differences between the two groups of patients, impairing comparability in the variables of age, sex, comorbidities, initial: PaFi, CRP, DHL, Ferritin, D-dimer, or use of antibiotics.
Colchicine was prescribed to patients Upon completing 4 days of treatment with parenteral corticosteroid, the paraclinical markers of severity decreased significantly in the group that received MTP, with CRP 2. Transfer to the intensive care unit and mortality after starting the corticosteroid was lower in the group that received MTP 4. Table 2. Recovery time was shorter in the patients treated with MTP, three days 3—4 vs.
Fig 2. Survival function estimated by the Cox model, according to whether they received corticosteroid with colchicine. Cumulative hazard function estimated by the Cox model if the drug colchicine was added to the corticosteroid. Therefore, corticosteroids have been used, drugs with powerful anti-inflammatory action [ 19 ].
As a historical background, in the SARS epidemic in Guangzhou, China, which occurred in , the infection was associated with a clinical picture similar to the current disease Covid, Zhao et al. Only the patients who received methylprednisolone in high doses of mg per day for 5 to 14 days did not require mechanical ventilation, without presenting mortality.
At the beginning of the Covid pandemic, the administration of corticosteroids was controversial [ 21 ]. Villar et al. In this study, patients who received dexamethasone had a decrease in mortality in a third of ventilated patients and in a fifth in other patients who received oxygen only. However, the difference in all patients mortality was In Covid patients, the high mortality can be explained by the rapid development of Organized Pneumonia secondary to SARS-CoV2, since its appearance even in the first week of infection has been documented in autopsies.
This pathology generally requires treatment with high doses of corticosteroids, cited by some as "pulse" doses and longer duration. Yang et al. Edalatifard et al. Patients with clinical improvement were higher in the methylprednisolone group than in the standard care group You should wait three months after your last dose of methylprednisolone before you receive the smallpox vaccine. If you have an allergic reaction, call your doctor or local poison control center right away.
If your symptoms are severe, call or go to the nearest emergency room. Doing so can increase the levels of methylprednisolone in your blood. For people with heart disease : This drug can increase your blood pressure. It can also cause your body to retain salt and water. Tell your doctor about your history of heart disease.
You might need to test your blood sugar level more often. Tell your doctor about your history of diabetes. For people with ulcers: This drug may cause stomach bleeding.
Tell your doctor if you have an ulcer or have had an ulcer in the past. For people with glaucoma : This drug can increase the pressure in your eyes if you take it for a long time.
Tell your doctor if you have glaucoma or any other eye-related illness before you start taking this drug. For people with infections: This drug may make it harder for your body to fight off your infection. Ask your doctor if this drug is safe for you. For people with liver problems: If you have cirrhosis , you may not be able to process this drug as well. This may increase the levels of methylprednisolone in your body and cause more side effects.
Your doctor may start you on a lower dosage depending on your liver function. For people with hypothyroidism : You have a higher risk of side effects from this drug. Tell your doctor about your history of thyroid disease. You may need a lower dosage of this drug.
For people with herpes of the eye: Ask your doctor if this drug is safe for you. You may have a higher risk of side effects. For people with systemic sclerosis : Corticosteroids, including this drug, increase your risk of scleroderma renal crisis. Key symptoms of this condition include kidney failure and increased blood pressure.
Your doctor will monitor you carefully if you have systemic sclerosis and you take methylprednisolone. Methylprednisolone should only be used during pregnancy if the benefits outweigh potential risks to the pregnancy.
For women who are breastfeeding: Methylprednisolone may pass into breast milk and cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or to stop taking this medication.
For seniors: The kidneys of older adults may not work as well as they used to. Children should use the lowest effective dosage of this drug to decrease the risks of slowed growth. Methylprednisolone oral tablet is used for long-term or short-term treatment. Your length of treatment depends on your condition and how your body responds to treatment.
This drug can disrupt how your body controls hormones. Stopping it suddenly can cause side effects. If you need to stop taking this drug, your doctor will slowly lower your dosage.
This will reduce your risk of side effects. For this drug to work well, a certain amount needs to be in your body at all times. If you take too much: You could have dangerous levels of the drug in your body.
Signs and symptoms of an overdose of this drug can include:. But if your symptoms are severe, call or go to the nearest emergency room right away. What to do if you miss a dose: If you miss a dose, take it as soon as you can.
You may need to miss a dose or take an extra dose. How to tell if the drug is working: The inflammation caused by your condition should decrease. Keep these considerations in mind if your doctor prescribes methylprednisolone oral tablet for you. A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. If you are taking steroids for asthma , you may wonder how long steroids stay in your system.
This will vary depending on the type of drug, whether you are taking an inhaled medication such as Advair fluticasone and salmeterol or oral corticosteroid e. Specifically, the drug's half-life will determine how long a drug circulates within your body. A major factor in how long any drug affects your body is the drug's half-life.
In simple terms, the half-life of a drug is the time it takes for half of the drug's dosage to be eliminated from your body. For example, the half-life of rescue inhalers like albuterol is in the five- to seven-minute range, while the half-life of Advair is five to seven hours.
The half-life of a drug affects several things, including how quickly you'll notice it working and how often you'll need to take it. A number of different factors can affect the half-life of a drug, including:. While half-life is mostly related to the properties of the drug, each body is unique, which means how a drug is metabolized by your body may differ from how the same drug at the same dosage affects another person. Oral corticosteroids , sometimes referred to as oral steroids or even by a generic name such as prednisone, are a group of powerful anti-inflammatory medications that are prescribed when you have a significant worsening of your asthma symptoms.
They may be used over several days to help get your symptoms under control. Inhaled steroids, by contrast, are localized to the lungs, which reduces the risk of broader side effects. Although people with asthma routinely have been advised to use an inhaled steroid daily, according to updated recommendations for asthma management by the National Institutes of Health NIH issued in December , this no longer is regarded as necessary for those with mild to moderate persistent asthma.
If you use an inhaler daily to manage asthma, talk to your healthcare provider about how the new guidelines might affect your treatment. Oral corticosteroids are systemic—meaning they reduce inflammation throughout the entire body. Inhaled steroids, on the other hand, act primarily in the lungs. It is helpful to understand the differences between oral corticosteroids and inhaled steroids. This can occur when prescription instructions are not followed exactly as directed.
The half-life of oral corticosteroids is significantly longer than inhaled steroids, and therefore oral steroids have a more significant side effect profile, including:. It is key to mention any recent steroid bursts the use of a short course of oral steroids to your healthcare provider. Overuse of oral steroids may prevent your adrenal gland, where your body's natural steroids are made, from working correctly.
As a result, your body may not make steroids sufficiently during a time of stress and you may require additional supplementation. Inhaled steroids rarely cause these side effects, but do have local side effects that are easily prevented with appropriate steps. Side effects of inhaled steroids are rare but may include:. These symptoms may be avoided by rinsing your mouth and gargling after using an inhaled steroid, as well as using a spacer device that delivers measured doses.
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