Methylprednisolone in the treatment of post-COVID-19 Interstitial Lung Disease (STERCOV-ILD)

ABSTRACT

Introduction: Post-COVID-19 Interstitial Lung Disease (ILD) is controversial and need for treatment is unclear. Aim(s) To investigate the efficacy of methylprednisolone in the treatment of post-COVID-19 ILD. Method(s) This multicentre, prospective, randomized controlled clinical trial, included post-COVID ILD patients (ClinicalTrials.gov, NCT04988282). Post-COVID ILD was defined as the presence of respiratory symptoms, hypoxemia, restrictive lung functions and parenchymal infiltrates on thorax HRCT. 262 post-COVID-19 patients were randomly assigned to one of two arms the steroid group (n135) or control group (n127). For 4 weeks, the steroid group received oral methylprednisolone at a dose of 0.5 mg/kg/day (maximum dose 48 mg/day). At the end of the study, thorax HRCT, 6-minute walking test and lung function tests were re-evaluated. A good response was defined as a mMRC score of 0, a FVC percentage greater than 80% and absence of hypoxemia at rest or during exercise, greater than 90% resolution of lesions on CT. Result(s) Good clinical and functional response rates were higher in steroid group compared to the control group (62.9% vs 33.3%;54.1% vs 33.7%, p<0.001, respectively). Patients with a radiological response in steroid group tend to be higher than control group, but not statistically significant (61.1 % vs 51.1 %, p=0.159). The increase in oxygen saturation, FVC, and 6-minute walking distance were significantly higher in the steroid group compared to the control. Discussion(s) Systemic corticosteroids improves clinical and functional characteristics and increases oxygen saturation, FVC, and exercise capacity in post-COVID ILD patients compared to the natural course of the disease.