Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients

By N. Lee, K. C. Chan, D. Hui, E. Ng, A. Wu, R. Chiu, Vincent Wai-Sun Wong, P. Chan, K. Wong, E. Wong and 4 more. Journal of Clinical Virology, 2004

597 citations recorded by the source corpus.

Background: The effect of corticosteroid treatment on the viral load of Severe Acute Respiratory Syndrome (SARS) patients is unknown. Objective: To compare the plasma SARS-CoV RNA concentrations in ribavirin-treated patients who received early hydrocortisone therapy with those who received placebo. Study design: Serial plasma SARS-CoV RNA concentrations measured in the setting of a prospective, randomized double-blinded, placebo-controlled trial designed to assess the efficacy of “early” (<7 days of illness) hydrocortisone use in previously healthy SARS patients were analyzed. SARS-CoV RNA was quantified using a one-step real-time RT-PCR assay targeting the nucleocapsid gene. Results: Among 16 non-ICU cases, SARS-CoV RNA was detected in plasma since day 3–4 after fever onset; viral concentration peaked in the first week, which then rapidly declined in the second week of illness. On days 8, 12, 16, and 20, the cumulative proportion of patients with undetectable virus in plasma was 31%, 69%, 92%, and 100%, respectively. Plasma SARS-CoV RNA concentrations in the second and third week of illness were significantly higher in patients who received initial hydrocortisone treatment (n = 9), as compared to those who received placebo (n = 7)(AUC; Mann–Whitney, P = 0.023). The median time for SARS-CoV to become undetectable in plasma was 12 days (11–20 days) versus 8 days (8–15 days), respectively. Conclusion: Our findings suggested “early” corticosteroid treatment was associated with a higher subsequent plasma viral load.

Subfields: Endocrinology, Diabetes and Metabolism, Infectious Diseases, Neurology

View Paper: https://www.semanticscholar.org/paper/3cc19ab0730265040784a369c1f1bd7c4598ca58

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Citations in the corpus

On the Alert for Cytokine Storm: Immunopathology in COVID‐19 (2020, background): “although some data suggest that glucocorticoids could delay viral clearance (16).”
SARS: Systematic Review of Treatment Effects (2006, background): “Two studies contained evidence of possible harm from corticosteroids [21,22].”
Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review (2020, unknown): “Although they were widely used in management of severe acute respiratory syndrome (SARS), there was no good evidence for benefit, and there was persuasive evidence of adverse short- and long-term harm [42,43].”
Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection (2007, background): “It may increase the plasma viral load and the risk of nosocomial infections and avascular osteonecrosis (196).”
The deadly coronaviruses: The 2003 SARS pandemic and the 2020 novel coronavirus epidemic in China (2020, unknown): “A variety of other agents, including antiviral peptides and corticosteroids have been shown to be effective in vitro and/or in animal models [40, 41] .”
Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial (2020, methodology): “26 The frequent use of corticosteroids in our patient group might have promoted viral replication, as observed in SARS 27 and MERS, 28 although these studies only reported pro longation of the detection of viral RNA, not infectious virus.”
Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome (2017, background): “Observational studies in patients with SARS coronavirus found that highdose systemic corticosteroid therapy was associated not only with increased subsequent blood viral loads but also with adverse effects and increased mortality (5, 7).”
Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths (2020, unknown): “11 e 14 However, corticosteroid therapy could be associated with delayed MERS-CoV RNA clearance (adjusted hazard ratio, 0.35; 95% CI, 0.17 e 0.72; p Z 0.005) for critically ill patients with MERS, 40 and early corticosteroid treatment could be associated with higher subsequent plasma RNA load of SAR”