Getting confused now, about COVID and Prednisolone

[Dontwannabesick]

Getting confused now, about COVID and Prednisolone. I am told I am clinically extremely vulnerable because of my age, because I have been on prednisolone > 5mg for however long, and am on Methotrexate. So I am more likely to catch COVID. Yet the current wisdom is to treat COVID with prednisolone, which I am already taking. Que?

[MrsNails]

Hi DWBS

I’m also Extremely Clinically Vulnerable (ECV) Long Term Pred; MTX; Kidney Issues & Angina.

Although they do treat COVID-19 with Steroids it’s usually Dexamethasone (unless someone has more up to date info than me? PMRpro ? Dexamethasone lasts over a longer period of time & while if someone on Prednisolone may have their Pred increased if they are diagnosed with Covid-19 the Medics are not completely as convinced that we are more at risk than the general population as first thought. This could however been masked by the fact we are probably shielding more, much more likely to follow the hand washing, mask wearing & distancing advice.

Anyone who takes MTX has always been ‘At Risk’ of picking up more infections but with sensible precautions this should not be an issue. That is also why we have our bloods done regularly to ensure our white blood cell count isn’t falling too low.....

Try not to worry & follow the guidelines.

Kind Regards

MrsN

[PMRpro Ambassador in reply to MrsNails]

I think they use any of them - dexamethasone is stronger and needs a smaller dose so probably one tablet instead of umpteen. 10mg pred is the same as 1.5mg dexamethasone. and somewhere at the back of my mind is that I have seen 4mg as the dose - 30mg pred.

[MrsNails in reply to PMRpro]

Thanks Pro l wasn’t certain....

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Found this info from WHO site -

Last updated 16 October 2020

What is dexamethasone and does it work against COVID-19?

Does WHO recommend the use of dexamethasone for COVID-19 patients?

On 2 September 2020, WHO issued an interim guideline on the use of dexamethasone and other corticosteroids for the treatment of COVID-19. The guidelines were developed by a panel of WHO and international experts and investigators and is based on evidence collected from seven clinical trials.

The guidelines make two recommendations:

Recommendation 1:

WHO strongly recommends that corticosteroids (i.e. dexamethasone, hydrocortisone or prednisone) be given orally or intravenously for the treatment of patients with severe and critical COVID-19.

Recommendation 2:

WHO advises against the use of corticosteroids in the treatment of patients with non-severe COVID-19, unless the patient is already taking this medication for another condition.

Time and duration of medication should be once daily for 7-10 days.

Daily dose should be 6 mg of dexamethasone, equivalent to 160 mg of hydrocortisone (i.e. 50 mg every 8 hours or 100 mg every 12 hours), 40 mg of prednisone, 32 mg of methylprednisolone (8 mg every 6 hours).

The panel of experts made its recommendation on the basis of the moderate certainty evidence of a mortality reduction of 8.7% and 6.7% in patients with COVID-19 who are critically or severely ill.

[SheffieldJane]

I understood that we weren’t necessarily more likely to catch COVID but might face a tougher time, because of underlying health problems, if we got it. I also have a feeling that I read that COVID was being treated by drugs similar to our other drug ( Actemra) Tocilizumab. I can’t remember the source. It would be nice if this did confer some protection, but I somehow doubt it. I will continue my life as a sparkling,clean, recluse for now.

[Kendrew]

I asked same question and it was explained to me that being on steroids doesn't increase your chances of catching it...but it does increase your chances of reacting badly to it if you do, and developing a more severe illness. I don't have enough knowledge to comment on the second part of your post but there will be others who do.

[PMRpro Ambassador in reply to Kendrew]

That doesn't make sense though does it?

[Kendrew in reply to PMRpro]

I think what was meant, was that you only catch covid if you actually come into contact with the virus....be that through touching something infected with it or meeting a person who could transmit it to you. Being on steroids doesn't make you touch more potentially hazard objects or surfaces, or meet more potentially infected people than someone who isn't on steroids, so in that respect you're just as likely, or unlikely to contract it as anyone else. If you do however come into contact with it, then you're more likely to develop more serious complications than others. I maybe haven't explained that very well, but that was my understanding of what was meant.

[PMRpro Ambassador in reply to Kendrew]

I meant why should pred make you more likely to react badly when steroids are being used very successfully to reduce the likelihood of progression of the need for oxygen?

[Kendrew in reply to PMRpro]

Haha! Sorry.....well apparently....and this is just what my GP said!....steroids, as we now know, have been found to be very useful in remediating many of the complications associated with the later stages of the infection, but don't appear to prevent or stop the progression to those stages after you've initially caught it. Because steroids suppress your immune system, you're not able to overcome the infection before it's progressed further. It sounds feasible but who knows. I'd be interested to know what you think or if you've read anything different?

[PMRpro Ambassador in reply to Kendrew]

"but don't appear to prevent or stop the progression to those stages after you've initially caught it"

How's he work that one out? As I understand it, it is being given to patients who are at the CPAP stage of O2 requirement and seems to reduce the progression to requiring full ventilation.

[Kendrew in reply to PMRpro]

I think he was saying that already being on steroids is not a guarantee that if you get it you should expect to just recover ok, because it will still be more challenging to overcome it and you probably will still need some kind of medical intervention which may still involve hospitalization, however, the fact you're already on steroids will massively reduce the development of serious complications. I don't know whether he's right or wrong and I've not heard that synopsis anywhere else.

[PMRpro Ambassador in reply to Kendrew]

Mmmm - but NOTHING is likely to be a guarantee. At the present level of knowledge, even the vaccines won't be a guarantee that you won't get infected - nor that being assymptomatic as a result doesn't mean you aren't shedding virus. The Moderna one resulted in 100% avoidance of severe infection (they claim) but not 100% protection. And given Long Covid appears in young, otherwise healthy patients, many of whom were assymptomatic at the time, that means there will be some questions to answer there.

[Purple-Owl in reply to PMRpro]

I understand that severely ill covid patients are (probably) experiencing a cytokine storm, where the immune system suddenly goes crazy and attacks too violently. Maybe this is why pred can help here but not at earlier stages when the immune system should be helped not hindered?

[PMRpro Ambassador in reply to Purple-Owl]

By the time it gets to the cytokine storm it's probably too late to head it off at the pass with pred - then you need the tocilizumab effect.

[PainInTheDeltoids]

For what its worth, my Rheumy said that despite his hospital being overrun with Covid patients, he had not seen any more people in hospital with PMR/GCA on steroids and Covid together, than he would have expected to. Not that this 'trial of one physician's experience' may be statistically signifcant, but slightly reassuring that those of us "extremely clinically vulnerable" are not all about to pop our clogs!

[PMRpro Ambassador in reply to PainInTheDeltoids]

I have heard that said by other sources too - some of whom have been involved in studies.

[MrsNails in reply to PainInTheDeltoids]

Yes, my Consultant said the same & as a ‘group’ of patients we didn’t appear to be more easily affected. Wether that was/is because more of us Shielded & were very careful about mixing with other people......

[RoadTrip in reply to PainInTheDeltoids]

My private Rheumatologist said the same this week.

[PMRpro Ambassador]

I think the "long term above 5mg" bit will be the effect on the adrenal function - and when you are under stress, whatever it is, then the body would normally react with a boost of cortisol to cope with it, If someone on pred is hospitalised with Covid then the first action is to double the dose of pred they are on up to a maximum of 20mg.

But you aren't going to get off pred in a couple of months, not safely anyway, and you can't change your history - you are supposed to carry a steroid card for a year after stopping steroids because it is acknowledged that it can take that long to get back to reliable function even after stopping pred altogether.

[JGBH in reply to PMRpro]

Although I have been on steroids for over 2 years I was never given a steroid card to carry with me at all times. Should my GP or pharmacist have given this to me?

[PMRpro Ambassador in reply to JGBH]

They should really - if you are in the UK at least. But there doesn't appear to be widespread awareness of it for some reason! I think the pharmacist gave me mine, long time ago now! You are supposed to keep the dosage up to date so that does tend to mean needing replacements.

[JGBH in reply to PMRpro]

Thanks for your prompt reply. Yes I live in the UK. I will phone the pharmacist and request a card.

[Koalajane in reply to JGBH]

My pharmacist gave me mine and also a replacement

[JGBH in reply to Koalajane]

You’re lucky to have such an aware pharmacist. It looks like most GPs and pharmacists haven’t got a clue. Rather strange since they’re supposed to look after our health.

[Koalajane in reply to JGBH]

I also got one from PMR/GCA uk when I became a member

[Rache]

Although all the guidelines say we should be given a steroid card, I have been met with blank looks any time I have asked for one! Initially asked GP, then GP reception, then at various pharmacies. Only place I have got them has been on joining, and then on renewing, my PMRGCA membership

[PMRpro Ambassador in reply to Rache]

There are templates online for downloading and printing

[Rache]

Thanks PMRpro. I eventually discovered this. Still feel they should be given to patients as a matter of course. If people don’t know about them, they won’t know to ask or to download them

[PMRpro Ambassador in reply to Rache]

They used to be - maybe it is something to do with training nowadays. I am astounded at times at the things some community pharmacists don't know!

[Rache]

Agree. Repeatedly astounded by things medical people, GPs, nurses etc don’t know. This forum has been a lifesaver to me. I have learned that I have to research and take care of my own health