Impact of dexamethasone on SARS-CoV-2 concentration kinetics and antibody response in hospitalized COVID-19 patients: results from a prospective observational study
Authors: Barbara Mühlemann, Charlotte Thibeault, David Hillus, Elisa T. Helbig, Lena J. Lippert, Pinkus Tober-Lau, Tatjana Schwarz, Marcel A. Müller, Martin Witzenrath, Norbert Suttorp, Leif E. Sander, Christian Drosten, Terry C. Jones, Victor M. Corman, Florian Kurth, Stefan Hippenstiel, Sascha S. Haenel, Mirja Mittermaier, Fridolin Steinbeis, Tilman Lingscheid, Bettina Temmesfeld-Wollbrück, Thomas Zoller, Holger Müller-Redetzky, Alexander Uhrig, Daniel Grund, Christoph Ruwwe-Glösenkamp, Miriam S. Stegemann, Katrin M. Heim, Ralf H. Hübner, Bastian Opitz, Kai-Uwe Eckardt, Martin Möckel, Felix Balzer, Claudia Spies, Steffen Weber-Carstens, Frank Tacke, Chantip Dang-Heine, Michael Hummel, Georg Schwanitz, Uwe D. Behrens, Maria Rönnefarth, Sein Schmidt, Alexander Krannich, Christof von Kalle, Linda Jürgens, Malte Kleinschmidt, Sophy Denker, Moritz Pfeiffer, Belén Millet Pascual-Leone, Luisa Mrziglod, Felix Machleidt, Sebastian Albus, Felix Bremer, Jan-Moritz Doehn, Tim Andermann, Carmen Garcia, Philipp Knape, Philipp M. Krause, Liron Lechtenberg, Yaosi Li, Panagiotis Pergantis, Till Jacobi, Teresa Ritter, Berna Yedikat, Lennart Pfannkuch, Christian Zobel, Ute Kellermann, Susanne Fieberg, Laure Bosquillon de Jarcy, Anne Wetzel, Christoph Tabeling, Markus C. Brack, Moritz Müller-Plathe, Jan M. Kruse, Daniel Zickler, Andreas Edel, Britta Stier, Roland Körner, Nils B. Müller, Philipp Enghard, Paula Stubbemann, Nadine Olk, Willi M. Koch, Alexandra Horn, Katrin K. Stoyanova, Saskia Zvorc, Lucie Kretzler, Lil A. Meyer-Arndt, Linna Li, Isabelle Wirsching, Denise Treue, Dana Briesemeister, Jenny Schlesinger, Birgit Sawitzki, Lara Bardtke, Kai Pohl, Philipp Georg, Daniel Wendisch, Anna L. Hiller, Sophie Brumhard, Marie Luisa Schmidt, Leonie Meiners, Patricia Tscheak
Journal: Clinical Microbiology and Infection (2021)

Dexamethasone has become the standard of care for severe coronavirus disease 2019 (COVID-19), but its virological impact is poorly understood. The objectives of this work were to characterize the kinetics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) concentration in the upper respiratory tract (URT) and the antibody response in patients with (D+) and without (D-) dexamethasone treatment.Data and biosamples from hospitalized patients with severe COVID-19, enrolled between 4th March and 11th December 2020 in a prospective observational study, were analysed. SARS-CoV-2 virus concentration in serial URT samples was measured using RT-PCR. SARS-CoV-2-specific immunoglobulins A and G (IgA and IgG) were measured in serum samples using S1-ELISA.We compared 101 immunocompetent patients who received dexamethasone (according to the inclusion criteria and dosage determined in the RECOVERY trial) to 93 immunocompetent patients with comparable disease severity from the first months of the pandemic, who had not been treated with dexamethasone or other glucocorticoids. We found no inter-group differences in virus concentration kinetics, duration of presence of viral loads >106 viral copies/mL (D+ median 17 days (IQR 13-24), D- 19 days (IQR 13-29)), or time from symptom onset until seroconversion (IgA: D+ median 11.5 days (IQR 11-12), D- 14 days (IQR 11.5-15.75); IgG: D+ 13 days (IQR 12-14.5), D- 12 days (IQR 11-15)).Dexamethasone does not appear to lead to a change in virus clearance or a delay in antibody response in immunocompetent patients hospitalized with severe COVID-19.