Glucocorticoid Therapy in Coronavirus Disease COVID-19 Patients

Study Overview
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Brief Summary
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Treatment with glucocorticoids in COVID patients. Low-intervention, phase IV, open-label, randomised, low-intervention clinical trial comparing 2 active treatments.

Detailed Description
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The use of high-dose bolus glucocorticoids in the treatment of patients with COVID-19 infection will increase the anti-inflammatory effect without increasing side effects. This will allow a better patient outcome, reducing the number of deaths and the need for intubation or admission to the Intensive Care Unit.

Official Title
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MP3-pulses-COVID-19. Methylprednisolone Pulses Versus Dexamethasone According RECOVERY Protocol in Patients With Pneumonia Due to SARS-COV-2 Coronavirus Infection

Conditions
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Corona Virus Infection

Intervention / Treatment
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* Drug: Dexamethasone
* Drug: Methylprednisolone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over 18 years of age Inpatient Diagnosis of SARS-CoV-2 infection confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) or antigen They present evidence in computerized axial tomography (CT) of pulmonary involvement attributed to the infection by COVID. Patients in whom CT scans are not performed must have suspected pulmonary involvement by clinical examination with simple compatible or suggestive radiology. Requires supplementary oxygen due to basal saturation ≤ 93% (with ambient O2, 21%) Exclusion Criteria: The patient's situation is so serious that the doctor in charge thinks he could die within 24 hours. At the time of randomisation, patients require one of the following 4 ventilatory supports: high-flow oxygen devices. non-invasive mechanical ventilation. invasive mechanical ventilation. Extracorporeal membrane oxygenation (ECMO). The patient is or has been treated in the 2 weeks prior to randomisation with glucocorticoids or inflammation modifying drugs, both conventional (thiopurines, cyclophosphamide, cyclosporine, tacrolimus), leflunomide, methotrexate, mycophenolate mofetil/mycophenolic acid, sulfasalazine, hydroxychloroquine or chloroquine) as synthetics or biologics directed against therapeutic targets (abatacept, belimumab, CD-20, IL1, IL6, Il12. 23, IL-23, Il.17, TNF, integrin α4β7 or Janus kinase inhibitors JAK). Patients who are only on maintenance treatment with doses of steroids less than or equal to 7.5 mg of prednisone or equivalent per day will not be excluded. The patient is pregnant or breastfeeding. The patient has a chronic renal disease is stage 4 or 5 (CCr <30 ml/min). Moderate to severe dementia at the investigator's discretion. Hypersensitivity to any of the active ingredients or to any of the excipients included in its formulation. Untreated systemic infections not caused by COVID-19. Active stomach or duodenal ulcer. Recent vaccination with live vaccines. Other infection or disease that explains the lung disorder. Inability of the patient to understand the study or to sign the informed consent unless consent is delegated to a legal representative. Active participation in another clinical study in the last 15 days.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Open-label, randomised clinical trial comparing 2 active treatments. Low-intervention clinical trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: RECOVERY<br>intermediate-dose dexamethasone (6mg/24h - 10 days) | Drug: Dexamethasone<br>* 6 mg/24h - 10 days<br>* Other names: Recovery;|
| Experimental: BOLUS<br>high-dose methylprednisolone bolus (250mg/4h - 3 days) | Drug: Methylprednisolone<br>* 250 mg/ 24h - 3 days<br>* Other names: Bolus;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality rate in COVID-19 patients after high-dose methylprednisolone bolus administration versus mortality rate intermediate-dose dexamethasone pattern (RECOVERY trial) | Mortality rate (percentage) | 28 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Admission in Intensive Unit Care (ICU) | Incidence of ICU admission | 28 days | 
| Evaluation of respiratory support requirements | Proportion of patients (number of cases with respiratory support requirement / total number of patients) with non-invasive mechanical ventilation and/or high-flow oxygen requirements. Proportion of patients (number of cases with respiratory support requirement / total number of patients) with invasive mechanical ventilation or intubation requirements. | 28 days | 
| Days in hospital | Number of days in hospital from the star of the treatment until discharge | 28 days | 
| Evaluation of presence of adverse events related with use of high dose of glucocorticoids. | Presence or absence of adverse effects (infections, hyperglycaemia, psychotic states or other adverse effects). Incidence of infections, hyperglycaemia, psychotic states or other adverse effects, if applicable | 28 days | 
| Evaluation of other immunosuppressors requirements. | Occurrence of use of other immunosuppressors (active substance, dose, duration, if applicable) | 28 days | 
| Status according to the World Health Organization (WHO) 10-category scale. | Clinical evaluation of patient status according to the WHO 10-category scale. | 3 months |