A Retrospective Evaluation of Combination Therapy of Methylprednisolone and Remdesivir for Severe COVID-19 Patients

Abstract

Introduction: Severe and threatening complications of Corona Virus Disease-2019 (COVID-19) are caused by direct viral injury as well as excessive and aberrant host immune response induced by the virus. In this context, use of Methylprednisolone (MP) to prevent cytokine storm and Remdesivir to prevent viral replication seems prudent. Aim: To assess the clinical outcome of combination therapy of Remdesivir and MP pulse therapy in patients with severe COVID-19 in Intensive Care Unit (ICU). Materials and Methods: The retrospective study was conducted in the COVID-19 ICU, dealing exclusively with 21 severe illness severe illness cases at Safdurjung Hospital, New Delhi, India from June to July 2020. They were given MP pulse therapy (500 mg/day for three days, followed by 1 mg/kg orally once daily, tapered by 10 or 20 mg/day and finishing with 10 mg) along with intravenous Remdesivir. Pre and post-therapy examination of the patients included clinical features, inflammatory markers (Interleukin-6, ferritin and D-dimer), gas parameters like ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and changes in chest radiograph. Values of PaO2/ FiO2, inflammatory markers on day 1 and day 3 were expressed as mean±SD and their difference compared using student t-test. Statistical significance was defined as p<0.05. Results: This treatment regimen was associated with significant improvement in PaO2/FiO2 (p<0.001), significant decrease in inflammatory markers (p<0.001) and reversal of radiological changes. Ten patients were discharged within two weeks of treatment while six patients were shifted to high dependency unit for further oxygen requirement. They were all successfully discharged from hospital without oxygen requirement within next two weeks. Five patients developed opportunistic infections and succumbed to death. Side-effects of therapy included hyperglycaemia in nine patients, which was managed by insulin infusion. Conclusion: Combination therapy of MP pulse and Remdesivir in patients with severe COVID-19 resulted in significant clinical improvement. Given the high efficacy, it could be one of the promising approaches to the management of patients with severe COVID-19.