Assessment of Clinical Efficacy of Dexamethasone in Patients with Moderate COVID-19

The host immune response, primarily manifested by hypercytokinemia, obviously plays a key role in the development of severe novel coronavirus disease, COVID-19. Currently, numerous therapies aimed at suppressing the hyperinflammatory response and the "cytokine storm" are being investigated. One of these methods is the use of corticosteroids, particularly dexamethasone.

The aim was to assess the clinical efficacy of dexamethasone in patients with moderate bilateral multifocal pneumonia caused by SARS CoV-2 virus.

Material and methods. Sixty-nine patients aged from 31 to 88 years hospitalized in Almazov National Research Center and the Semashko City Hospital No 38 with SARS CoV-2 coronavirus infection complicated by moderate (semiquantitative visual pulmonary lesion grading system CT 2-3 corresponding to 25-50% and 50-75% parenchymal involvement, respectively) community-acquired bilateral multifocal pneumonia were retrospectively studied. Group 1 included 39 patients with moderate coronavirus infection who received therapy according to the current version of the temporary guidelines (TG) of the Ministry of Health of the Russian Federation, including dexamethasone. The drug was administered parenterally twice daily in a dosage of 12 mg in the morning and 8 mg in the evening for the first three days, then the dose was gradually reduced over 5-7 days. No Interleukin-6 inhibitors were administered to patients in this group. Group 2 was composed of 30 patients who received therapy according to the current version of TG, including a parenteral interleukin-6 inhibitor (tocilizumab, olokizumab, or sarilumab) following the standard regimen. Patients in this group were not administered with dexamethasone.

Results. CT scans corresponding to severity grade 3 and 4 (50-75% and >75% involvement, respectively) lung lesions on Day 7 were found in 35.89% of group 1 patients, while similar CT scans were found in 50% of patients who received interleukin-6 inhibitors (P=0.33). On Day 14 no significant differences in this parameter were revealed as well. Duration of fever in the dexamethasone group was 3.69 (0.62;6.76) days, while in the control group it was 3.95 (0.61;7.29) days (P=0.98). There was a tendency to decreased blood Creactive protein (CRP) values in the dexamethasone group on days 5 and 7. The frequency of transfer of patients to the ICU and hospital stay duration did not differ significantly between the groups.

Conclusion. Dexamethasone has comparable clinical efficacy with IL-6 antagonists in the comprehensive treatment of patients with moderate COVID-19 disease, which is confirmed by the chest CT evolution, duration of fever, and changes in serum CRP.

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