key: cord-0683648-yoxsqy7s
authors: Edalatifard, Maryam; Akhtari, Maryam; Salehi, Mohammadreza; Farhadi, Elham; Jamshidi, Ahmadreza; Mahmoudi, Mahdi; Rostamian, Abdolrahman
title: Is high-dose glucocorticoid beneficial in COVID-19? Response to Correspondence
date: 2021-02-18
journal: Eur Respir J
DOI: 10.1183/13993003.00324-2021
sha: 226b41171200574faff8c38f87aaf5888749bf62
doc_id: 683648
cord_uid: yoxsqy7s

Our clinical trial supports the beneficial use of a high dose of methylprednisolone for the ‎treatment of severe COVID-19 patients.‎

Muthu and colleagues expressed that clinical improvement in our study was defined by quick fever subsidence and a sense of well-being in subjective parameters. We postulated that hospital discharge was performed based on the national discharge protocol for COVID-19 at that time in our trial and the clinical improvement was determined based on SO2 more than 93%, BORG score more than 3, stopped fever for 3 days, improved dyspnea, normal urinary output, tolerated oral regimen (PO), and reduced C-reactive protein (CRP) level without any treatment adverse effects. However, we followed up discharged patients in both groups, and the general symptoms, clinical features, and characteristics of the recovered patients were also evaluated one week after discharge time. The data regarding patients' clinical features 7 days after discharge time were presented in Supplementary Muthu et al. also declared that a higher prevalence of diabetes mellitus (DM) in the control group in our study resulted in reduced adverse events in the intervention group. Since the patients in our study were randomly allocated into two groups, we did not match them according to their coexisting conditions. Although the prevalence of DM in the patients of the usual care group was higher, the level of respiratory rate and the level of heart rate were significantly elevated in the methylprednisolone group. Besides, the number of patients who have pulmonary involvement upper than 70%, and the number of patients who need non-invasive ventilation or reservoir mask before enrollment was higher in the methylprednisolone group.

Besides, we did not observe a difference in the level of patients' blood sugar regarding their clinical status. It is worth mentioning that uncontrolled DM is one of our exclusion criteria and COVID-19 patients with uncontrolled DM were excluded from this study [1] . Regarding the use of high doses of glucocorticoid and an increased risk of infectious complications in patients, we emphasised that we did not see any infectious adverse events in the methylprednisolone group including COVID-associated pulmonary aspergillosis and mucormycosis.

To conclude, we appreciate the interest of Muthu and colleagues in our article and appreciate the opportunity to share our experience regarding using glucocorticoids for the treatment of COVID-19 patients. Our data support the beneficial use of a high dose of methylprednisolone for the treatment of severe COVID-19 patients, however, more clinical studies with a higher sample size are needed.

Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomised controlled clinical trial

Dexamethasone in Hospitalized Patients with Covid-19 -Preliminary Report

Clinical Characteristics and Outcomes of 905 COVID-19 Patients Admitted to Imam Khomeini Hospital Complex in the Capital City of Tehran, Iran