Effect of treatment regimens in severe COVID pneumonia at an Indian tertiary care hospital: An observational, real-world study

Manu Chopra; Aditya Joshi; Saikat Dey; Rajan Kapoor; Ranjith K Nair; Sharad Bhalla; Ajith Nilakantan

doi:10.1016/j.mjafi.2022.05.009

Effect of treatment regimens in severe COVID pneumonia at an Indian tertiary care hospital: An observational, real-world study

Med J Armed Forces India. 2022 Oct;78(4):469-474. doi: 10.1016/j.mjafi.2022.05.009. Epub 2022 Jul 19.

Authors

Manu Chopra¹, Aditya Joshi², Saikat Dey³, Rajan Kapoor⁴, Ranjith K Nair⁵, Sharad Bhalla⁶, Ajith Nilakantan⁷

Affiliations

¹ Pulmonologist, Command Hospital (Eastern Command), Kolkata, India.
² Intensivist (Anaesthesia), Command Hospital (Eastern Command), Kolkata, India.
³ Medical Officer, Command Hospital (Eastern Command), Kolkata, India.
⁴ Head of Department (Medicine), Command Hospital (Eastern Command), Kolkata, India.
⁵ Commandant, Military Hospital Jaipur, India.
⁶ Microbiologist, Command Hospital (Eastern Command), Kolkata, India.
⁷ Commandant, Command Hospital (Eastern Command), Kolkata, India.

Abstract

Background: Corticosteroids have attracted attention as a treatment option for severe Coronavirus disease (COVID-19). However, published data on steroid therapy is debatable, and real-world data is lacking. This study evaluated the effect of treatment regimens, especially Pulse steroid therapy (Injection Methyl Prednisolone 250 mg iv once a day for three days) in severe-COVID-19 pneumonia at an Indian tertiary care hospital.

Methods: This observational cross-sectional study included severe COVID-19 pneumonia patients aged >18 years, requiring assisted ventilation. As part of the hospital protocol, patients received either pulse steroid therapy, remdesivir or tocilizumab in addition to the recommended steroid doses i.e., injection of dexamethasone 6 mg iv once a day. The association of factors and treatment regimens to patient outcomes was evaluated.

Results: Data of eighty-three patients were assessed, majority being above 60 years (n = 30, 36.14%) and males (n = 45/83, 54.21%). The commonest comorbidities were hypertension (n = 26), diabetes (n = 23) and obesity (n = 19), fifty-five patients (66.26%) reported at least one comorbidity. Sixty-one patients (73.49%) had received pulse steroid regimen, forty-eight patients (57.83%) were administered remdesivir-based regimen while twelve patients (14.46%) had received tocilizumab treatment. 54.1% patients managed with pulse steroid regimens were discharged after treatment, statistically similar to remdesivir-managed subgroup (62.5%, p > 0.05). On sub-group analysis, pulse steroids showed better outcomes in young males with no comorbidities. No comorbidity had significant relationship with patient outcomes (p > 0.05).

Conclusion: Pulse steroid therapy is an effective therapy in management of patients with severe COVID-19 pneumonia in a real-world setting, with better outcomes in young males without comorbidities. Pulse steroids can be considered a viable option for severe-COVID-19 pneumonia management.

Keywords: Pulse steroids; Remdesivir; Severe COVID; Tocilizumab.