Prednisone and Covid-19: PMR has been described as... - PMRGCAuk

PMRGCAuk

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Prednisone and Covid-19

4 years ago•3 Replies

PMR has been described as our immune system overreacting to some assault to our bodies. Some of what I am reading about Covid-19 seems to indicate that the same thing happens to those who have such severe reactions to the virus. I am wondering why prednisone isn't being considered as a possible treatment. Doesn't it seem like it could be a viable treatment?

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Whitner

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4 years ago

Hi, we have had a few conversation about pred/steroid treatment being tried in China, but it actually made the condition worse in some cases. Research is ongoing if you Google covid and prednisolone. Early application Vs later, high dose Vs low dose. Animal models and human cases in China.

You can check out the covid chats and research.

Yellowbluebell4 years ago

As this has been discussed before and because there are the covid posts available to read I am stoppong replies to this post. YBB

PMRproAmbassador4 years ago

This is a SARS virus - also called SARS Co-2 - and in the original SARS Co-1 outbreak in 2003 they did use steroids amongst a range of other drugs.

ncbi.nlm.nih.gov/pmc/articl...

is a retrospective summary of all the work was done and really it is clear nothing was done in a structured enough way on enough patients to come to any real conclusions.

In the case of steroids:

"Corticosteroids were commonly prescribed to SARS patients with worsening pulmonary disease or progressing abnormalities on chest X-rays. Treatment regimens varied widely but can be classified into two groups, early treatment and rescue treatment given at a later stage of illness. It is difficult to make a clear recommendation about whether corticosteroids should be used to treat SARS-associated lung injury in any stage of illness, particularly as the drug is immunosuppressive and may delay viral clearance if given before viral replication is controlled [21]. Of added concern are infectious complications, avascular necrosis, and steroid-induced psychosis—recognized adverse effects of corticosteroid use. Fungal superinfection and aspergillosis have been noted in case reports and autopsy findings of SARS patients given corticosteroids at high doses or for prolonged periods [32,33]. This review has found evidence of avascular necrosis and steroid-induced psychosis in SARS patients."

They probably did use massive doses - so the potential for adverse effects was high. The effect wasn't clear enough and so their use is not widespread.

In the end it pretty much died out because the lockdown then was far harsher and effective and soon even the work on a vaccine became rather patchy because there was no perceived need. Luckily a few places continued with the work relating to SARS and, later, MERS - and that is why, together with the advances in genetics and techniques, some groups are a long way ahead of the game now. Had they had a vaccine for SARS Co-1 it would probably have resulted in a vaccine far sooner now - once they know a type is safe, they can create a new one without a lot of testing. That is what happens with the annual flu vaccines and what will have to happen with Covid-19 for a really safe situation to avoid simiar pandemics to this one.

The mechanism of this disease is different in all sorts of ways - apparently it isn't the same sort of ARDS (acute respiratory distress syndrome) as the ones they are familar with. It is being said it may be more like altitude sickness with the pulmonary oedema that occurs there. There is a lot still to find out about it - and the sad truth is that it would need to last longer to have enough patients to trial drugs properly to identify one that really works. Some that appeared good inititally have turned out to not be the breakthrough some people thought. But they do seem to have made progress on care approaches that are better - they found fairly early in Italy that keeping patients off ventilators as long as possible helped and in the end the death rate of intubated patients was about 25% I believe. In New York the comparable death rate was well over 75% which is a similar figure to what I understood was suggested on Sky News this morning for the UK. Use of the sort of CPAP machines used in sleep apnoea reduces the death rate a lot.

There is a lot to learn - and they need to learn it. Unless things change a lot, this is just the first of more such pandemics.

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