Response to Glucocorticoid Therapy in Patients with Mild to Moderate Coronavirus Disease 2019 at a Japanese Care Facility

Response to Glucocorticoid Therapy in Patients with Mild to Moderate Coronavirus Disease 2019 at a Japanese Care Facility

Akiko Kikuchi,^1,2 Ryutaro Arita,¹ Rie Ono,¹ Yasunori Tadano,¹ Natsumi Saito,¹ Tetsuya Akaishi,^1,2 Takeshi Kanno,¹ Minoru Osawa,^1,2 Shin Takayama,^1,2 Michiaki Abe,¹ Ko Onodera^1,3 and Tadashi Ishii^1,2,3

¹Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
²Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
³Department of General Practitioner Development, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

The fifth wave of the coronavirus disease 2019 (COVID-19) pandemic caused by delta variant infection depleted medical resources, and the Japanese government announced glucocorticoid use for outpatients. An appropriate outpatient-glucocorticoid treatment for COVID-19 has not been established; therefore, we created treatment manuals with indications for glucocorticoid administration in a care facility adequately equipped to manage patients with mild to moderate COVID-19. Thirty-eight patients (24 males, 14 females; mean age 40.5 ± 11.8 years) were treated with glucocorticoids from August 1 to October 1, 2021 [COVID-19 staging, mild (n = 1), moderate I (n = 19), and moderate II (n = 18)]. Patients were treated with 6.6 mg/day d.i.v. or 6 mg/day p.o. dexamethasone, or 20-30 mg/day p.o. prednisolone. The median (25^th-75^th percentile) number of days from the date of onset to glucocorticoid administration was 8.0 days (7.0-11.25 days). While 24 patients were hospitalized, the condition of 14 improved without hospitalization. The median number of days from glucocorticoid administration to hospitalization was 1.0 day (range, 1.0-1.0 day). In the non-hospitalized patients, the median number of days of glucocorticoid administration was 5.0 days (5.0-5.25 days). The mean number of days from glucocorticoid administration to discharge from the care facility for non-hospitalized patients was 8.4 ± 3.3 days. The adverse reactions among non-hospitalized patients included insomnia (n = 1) and mild liver dysfunction (n = 3). The present method of glucocorticoid administration can be safely used for patients with COVID-19 in care facilities.

Keywords —— coronavirus disease 2019; dexamethasone; glucocorticoids; outpatient; prednisolone

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Tohoku J. Exp. Med 2022, 257, 97-106.

Correspondence: Akiko Kikuchi, Department of Education and Support for Regional Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

e-mail: h-toyama@umin.ac.jp