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1. Contributors

Author

Amrein, Karin, primary, Bertsch-Gout, Marcel, additional, Borráz-León, Javier I., additional, Bui, Alexandra, additional, Chapman, Karen, additional, Chaudhuri, Dipayan, additional, Chen, Alon, additional, Chiappelli, Francesco, additional, Chrousos, George P., additional, Confalonieri, Marco, additional, Conway de Macario, Everly, additional, Cornell, Jessica, additional, Dantzer, Robert, additional, Dhabhar, Firdaus S., additional, Dong, Tao, additional, Dyrma, Sherina, additional, Eccles, Melissa, additional, Feldotto, Martin, additional, Gilardi, Josh, additional, Godbout, Jonathan P., additional, Gouin, Jean-Philippe, additional, Groth, David, additional, Hakamata, Yuko, additional, Hori, Hiroaki, additional, James, Eddie A., additional, Khakshooy, Allen, additional, Kuperman, Yael, additional, Lebow, Maya, additional, Lee, Royce, additional, Macario, Alberto J.L., additional, Marshall, Gailen D., additional, Matovic, Sara, additional, Meduri, G. Umberto, additional, Meibohm, Bernd, additional, Milligan Armstrong, Ayeisha, additional, Mitra, Sirsha, additional, Morris, Matthew C., additional, Patil, Chandrashekhar D., additional, Psarra, Anna-Maria G., additional, Rantala, Markus J., additional, Reder, Anthony T., additional, Rochwerg, Bram, additional, Rummel, Christoph, additional, Salinas, Shelbi, additional, Sheridan, John F., additional, Shukla, Deepak, additional, Sirisha, V.L., additional, Suprasanna, Penna, additional, Tang, Ming-Xuan, additional, Verdile, Giuseppe, additional, Volety, Ipsita, additional, Whiteside, Theresa L., additional, Woodfield, Amy, additional, Yin, Wenyuan, additional, Young, Morag, additional, and Zhou, Miou, additional

Published
2024
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2. Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia

Author

Meduri, G Umberto, Shih, Mei-Chiung, Bridges, Lisa, Martin, Thomas J, El-Solh, Ali, Seam, Nitin, Davis-Karim, Anne, Umberger, Reba, Anzueto, Antonio, Sriram, Peruvemba, Lan, Charlie, Restrepo, Marcos I, Guardiola, Juan J, Buck, Teresa, Johnson, David P, Suffredini, Anthony, Bell, W Andrew, Lin, Julia, Zhao, Lan, Uyeda, Lauren, Nielsen, Lori, and Huang, Grant D

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Pneumonia, Lung, Clinical Research, Pneumonia & Influenza, Clinical Trials and Supportive Activities, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Respiratory, Good Health and Well Being, Adult, Community-Acquired Infections, Critical Illness, Humans, Methylprednisolone, Respiration, Artificial, Treatment Outcome, ESCAPe Study Group, Community-acquired pneumonia, Glucocorticoids, Intensive care, Randomized clinical trial, Public Health and Health Services, Emergency & Critical Care Medicine, Clinical sciences
Abstract

PurposeSevere community-acquired pneumonia (CAP) requiring intensive care unit admission is associated with significant acute and long-term morbidity and mortality. We hypothesized that downregulation of systemic and pulmonary inflammation with prolonged low-dose methylprednisolone treatment would accelerate pneumonia resolution and improve clinical outcomes.MethodsThis double-blind, randomized, placebo-controlled clinical trial recruited adult patients within 72-96 h of hospital presentation. Patients were randomized in 1:1 ratio; an intravenous 40 mg loading bolus was followed by 40 mg/day through day 7 and progressive tapering during the 20-day treatment course. Randomization was stratified by site and need for mechanical ventilation (MV) at the time of randomization. Outcomes included a primary endpoint of 60-day all-cause mortality and secondary endpoints of morbidity and mortality up to 1 year of follow-up.ResultsBetween January 2012 and April 2016, 586 patients from 42 Veterans Affairs Medical Centers were randomized, short of the 1420 target sample size because of low recruitment. 584 patients were included in the analysis. There was no significant difference in 60-day mortality between the methylprednisolone and placebo arms (16% vs. 18%; adjusted odds ratio 0.90, 95% CI 0.57-1.40). There were no significant differences in secondary outcomes or complications.ConclusionsIn patients with severe CAP, prolonged low-dose methylprednisolone treatment did not significantly reduce 60-day mortality. Treatment was not associated with increased complications.

Published
2022

4. The ten reasons why corticosteroid therapy reduces mortality in severe COVID-19

Author

Arabi, Yaseen M., Chrousos, George P., and Meduri, G. Umberto

Subjects
Medical research -- Health aspects, Medicine, Experimental -- Health aspects, Corticosteroids -- Health aspects, Medical centers -- Health aspects, Mortality -- United Kingdom, Medical colleges -- Health aspects, Children -- Health aspects, Health care industry
Abstract

Author(s): Yaseen M. Arabi [sup.1], George P. Chrousos [sup.2], G. Umberto Meduri [sup.3] [sup.4] Author Affiliations: (1) grid.412149.b, 0000 0004 0608 0662, Intensive Care Department, King Abdullah International Medical Research [...]

Published
2020
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5. Prolonged higher dose methylprednisolone vs. conventional dexamethasone in COVID-19 pneumonia: a randomised controlled trial (MEDEAS)

Author

Salton, F, Confalonieri, P, Centanni, S, Mondoni, M, Petrosillo, N, Bonfanti, P, Lapadula, G, Lacedonia, D, Voza, A, Carpene, N, Montico, M, Reccardini, N, Meduri, G, Ruaro, B, Confalonieri, M, Citton, G, Bozzi, C, Tavano, S, Pozzan, R, Andrisano, A, Jaber, M, Mari, M, Trotta, L, Mondini, L, Barbieri, M, Ruggero, L, Antonaglia, C, Soave, S, Torregiani, C, Bogatec, T, Baccelli, A, Nalesso, G, Re, B, Pavesi, S, Barbaro, M, Giuliani, A, Ravaglia, C, Poletti, V, Scala, R, Guidelli, L, Golfi, N, Vianello, A, Achille, A, Lucernoni, P, Gaccione, A, Romagnoli, M, Fraccaro, A, Malacchini, N, Malerba, M, Ragnoli, B, Zamparelli, A, Bocchino, M, Blasi, F, Spotti, M, Miele, C, Piedepalumbo, F, Barone, I, Baglioni, S, Dodaj, M, Franco, C, Andrani, F, Mangia, A, Mancini, A, Carrozzi, L, Rafanelli, A, Casto, E, Rogliani, P, Ora, J, Carpagnano, G, Di Lecce, V, Tamburrini, M, Papi, A, Contoli, M, Luzzati, R, Zatta, M, Di Bella, S, Caraffa, E, Francisci, D, Tosti, A, Pallotto, C, De Rosa, F, Pecori, A, Franceschini, M, Carlin, M, Orsini, V, Pollastri, E, Rugova, A, Sabbatini, F, Soria, A, Rossi, M, Santantonio, T, Meli, R, Sauro, S, Fedeli, C, Mangini, E, Biolo, G, Nunnari, A, Pietrangelo, A, Corradini, E, Bocchi, D, Boarini, C, Zucchetto, A, Lanini, S, Salton F., Confalonieri P., Centanni S., Mondoni M., Petrosillo N., Bonfanti P., Lapadula G., Lacedonia D., Voza A., Carpene N., Montico M., Reccardini N., Meduri G. U., Ruaro B., Confalonieri M., Citton G. M., Bozzi C., Tavano S., Pozzan R., Andrisano A. G., Jaber M., Mari M., Trotta L., Mondini L., Barbieri M., Ruggero L., Antonaglia C., Soave S., Torregiani C., Bogatec T., Baccelli A., Nalesso G., Re B., Pavesi S., Barbaro M. P. F., Giuliani A., Ravaglia C., Poletti V., Scala R., Guidelli L., Golfi N., Vianello A., Achille A., Lucernoni P., Gaccione A. T., Romagnoli M., Fraccaro A., Malacchini N., Malerba M., Ragnoli B., Zamparelli A. S., Bocchino M., Blasi F., Spotti M., Miele C., Piedepalumbo F., Barone I., Baglioni S., Dodaj M., Franco C., Andrani F., Mangia A., Mancini A., Carrozzi L., Rafanelli A., Casto E., Rogliani P., Ora J., Carpagnano G. E., Di Lecce V., Tamburrini M., Papi A., Contoli M., Luzzati R., Zatta M., Di Bella S., Caraffa E., Francisci D., Tosti A., Pallotto C., De Rosa F. G., Pecori A., Franceschini M., Carlin M., Orsini V., Pollastri E., Rugova A., Sabbatini F., Soria A., Rossi M., Santantonio T., Meli R., Sauro S., Fedeli C., Mangini E., Biolo G., Nunnari A., Pietrangelo A., Corradini E., Bocchi D., Boarini C., Zucchetto A., Lanini S., Salton, F, Confalonieri, P, Centanni, S, Mondoni, M, Petrosillo, N, Bonfanti, P, Lapadula, G, Lacedonia, D, Voza, A, Carpene, N, Montico, M, Reccardini, N, Meduri, G, Ruaro, B, Confalonieri, M, Citton, G, Bozzi, C, Tavano, S, Pozzan, R, Andrisano, A, Jaber, M, Mari, M, Trotta, L, Mondini, L, Barbieri, M, Ruggero, L, Antonaglia, C, Soave, S, Torregiani, C, Bogatec, T, Baccelli, A, Nalesso, G, Re, B, Pavesi, S, Barbaro, M, Giuliani, A, Ravaglia, C, Poletti, V, Scala, R, Guidelli, L, Golfi, N, Vianello, A, Achille, A, Lucernoni, P, Gaccione, A, Romagnoli, M, Fraccaro, A, Malacchini, N, Malerba, M, Ragnoli, B, Zamparelli, A, Bocchino, M, Blasi, F, Spotti, M, Miele, C, Piedepalumbo, F, Barone, I, Baglioni, S, Dodaj, M, Franco, C, Andrani, F, Mangia, A, Mancini, A, Carrozzi, L, Rafanelli, A, Casto, E, Rogliani, P, Ora, J, Carpagnano, G, Di Lecce, V, Tamburrini, M, Papi, A, Contoli, M, Luzzati, R, Zatta, M, Di Bella, S, Caraffa, E, Francisci, D, Tosti, A, Pallotto, C, De Rosa, F, Pecori, A, Franceschini, M, Carlin, M, Orsini, V, Pollastri, E, Rugova, A, Sabbatini, F, Soria, A, Rossi, M, Santantonio, T, Meli, R, Sauro, S, Fedeli, C, Mangini, E, Biolo, G, Nunnari, A, Pietrangelo, A, Corradini, E, Bocchi, D, Boarini, C, Zucchetto, A, Lanini, S, Salton F., Confalonieri P., Centanni S., Mondoni M., Petrosillo N., Bonfanti P., Lapadula G., Lacedonia D., Voza A., Carpene N., Montico M., Reccardini N., Meduri G. U., Ruaro B., Confalonieri M., Citton G. M., Bozzi C., Tavano S., Pozzan R., Andrisano A. G., Jaber M., Mari M., Trotta L., Mondini L., Barbieri M., Ruggero L., Antonaglia C., Soave S., Torregiani C., Bogatec T., Baccelli A., Nalesso G., Re B., Pavesi S., Barbaro M. P. F., Giuliani A., Ravaglia C., Poletti V., Scala R., Guidelli L., Golfi N., Vianello A., Achille A., Lucernoni P., Gaccione A. T., Romagnoli M., Fraccaro A., Malacchini N., Malerba M., Ragnoli B., Zamparelli A. S., Bocchino M., Blasi F., Spotti M., Miele C., Piedepalumbo F., Barone I., Baglioni S., Dodaj M., Franco C., Andrani F., Mangia A., Mancini A., Carrozzi L., Rafanelli A., Casto E., Rogliani P., Ora J., Carpagnano G. E., Di Lecce V., Tamburrini M., Papi A., Contoli M., Luzzati R., Zatta M., Di Bella S., Caraffa E., Francisci D., Tosti A., Pallotto C., De Rosa F. G., Pecori A., Franceschini M., Carlin M., Orsini V., Pollastri E., Rugova A., Sabbatini F., Soria A., Rossi M., Santantonio T., Meli R., Sauro S., Fedeli C., Mangini E., Biolo G., Nunnari A., Pietrangelo A., Corradini E., Bocchi D., Boarini C., Zucchetto A., and Lanini S.

Abstract

Background Dysregulated systemic inflammation is the primary driver of mortality in severe coronavirus disease 2019 (COVID-19) pneumonia. Current guidelines favour a 7-10-day course of any glucocorticoid equivalent to dexamethasone 6 mg daily. A comparative randomised controlled trial (RCT) with a higher dose and a longer duration of intervention was lacking. Methods We conducted a multicentre, open-label RCT to investigate methylprednisolone 80 mg as a continuous daily infusion for 8 days followed by slow tapering versus dexamethasone 6 mg once daily for up to 10 days in adult patients with COVID-19 pneumonia requiring oxygen or noninvasive respiratory support. The primary outcome was reduction in 28-day mortality. Secondary outcomes were mechanical ventilation-free days at 28 days, need for intensive care unit (ICU) referral, length of hospitalisation, need for tracheostomy, and changes in C-reactive protein (CRP) levels, arterial oxygen tension/inspiratory oxygen fraction (PaO2/FIO2) ratio and World Health Organization Clinical Progression Scale at days 3, 7 and 14. Results 677 randomised patients were included. Findings are reported as methylprednisolone (n=337) versus dexamethasone (n=340). By day 28, there were no significant differences in mortality (35 (10.4%) versus 41 (12.1%); p=0.49) nor in median mechanical ventilation-free days (median (interquartile range (IQR)) 23 (14) versus 24 (16) days; p=0.49). ICU referral was necessary in 41 (12.2%) versus 45 (13.2%) (p=0.68) and tracheostomy in 8 (2.4%) versus 9 (2.6%) (p=0.82). Survivors in the methylprednisolone group required a longer median (IQR) hospitalisation (15 (11) versus 14 (11) days; p=0.005) and experienced an improvement in CRP levels, but not in PaO2/FIO2 ratio, at days 7 and 14. There were no differences in disease progression at the prespecified time-points. Conclusion Prolonged, higher dose methylprednisolone did not reduce mortality at 28 days compared with conventional dexamethasone in COVID

Published
2023

6. Corticosteroids in Patients Hospitalized With Community-Acquired Pneumonia : Systematic Review and Individual Patient Data Metaanalysis

Author

Ovidius Study Group, Capisce Study Group, and STEP Study Group, Briel, Matthias, Spoorenberg, Simone M. C., Snijders, Dominic, Torres, Antoni, Fernandez-Serrano, Silvia, Meduri, G. Umberto, Gabarrús, Albert, Blum, Claudine A., Confalonieri, Marco, Kasenda, Benjamin, Siemieniuk, Reed A.C., Boersma, Wim, Bos, Willem Jan W., and Christ-Crain, Mirjam

Published
2018

12. Prolonged higher dose methylprednisolone vs. conventional dexamethasone in COVID-19 pneumonia: a randomised controlled trial (MEDEAS)

Author

Salton F., Confalonieri P., Centanni S., Mondoni M., Petrosillo N., Bonfanti P., Lapadula G., Lacedonia D., Voza A., Carpene N., Montico M., Reccardini N., Meduri G. U., Ruaro B., Confalonieri M., Citton G. M., Bozzi C., Tavano S., Pozzan R., Andrisano A. G., Jaber M., Mari M., Trotta L., Mondini L., Barbieri M., Ruggero L., Antonaglia C., Soave S., Torregiani C., Bogatec T., Baccelli A., Nalesso G., Re B., Pavesi S., Barbaro M. P. F., Giuliani A., Ravaglia C., Poletti V., Scala R., Guidelli L., Golfi N., Vianello A., Achille A., Lucernoni P., Gaccione A. T., Romagnoli M., Fraccaro A., Malacchini N., Malerba M., Ragnoli B., Zamparelli A. S., Bocchino M., Blasi F., Spotti M., Miele C., Piedepalumbo F., Barone I., Baglioni S., Dodaj M., Franco C., Andrani F., Mangia A., Mancini A., Carrozzi L., Rafanelli A., Casto E., Rogliani P., Ora J., Carpagnano G. E., Di Lecce V., Tamburrini M., Papi A., Contoli M., Luzzati R., Zatta M., Di Bella S., Caraffa E., Francisci D., Tosti A., Pallotto C., De Rosa F. G., Pecori A., Franceschini M., Carlin M., Orsini V., Pollastri E., Rugova A., Sabbatini F., Soria A., Rossi M., Santantonio T., Meli R., Sauro S., Fedeli C., Mangini E., Biolo G., Nunnari A., Pietrangelo A., Corradini E., Bocchi D., Boarini C., Zucchetto A., Lanini S., Salton, F, Confalonieri, P, Centanni, S, Mondoni, M, Petrosillo, N, Bonfanti, P, Lapadula, G, Lacedonia, D, Voza, A, Carpene, N, Montico, M, Reccardini, N, Meduri, G, Ruaro, B, Confalonieri, M, Citton, G, Bozzi, C, Tavano, S, Pozzan, R, Andrisano, A, Jaber, M, Mari, M, Trotta, L, Mondini, L, Barbieri, M, Ruggero, L, Antonaglia, C, Soave, S, Torregiani, C, Bogatec, T, Baccelli, A, Nalesso, G, Re, B, Pavesi, S, Barbaro, M, Giuliani, A, Ravaglia, C, Poletti, V, Scala, R, Guidelli, L, Golfi, N, Vianello, A, Achille, A, Lucernoni, P, Gaccione, A, Romagnoli, M, Fraccaro, A, Malacchini, N, Malerba, M, Ragnoli, B, Zamparelli, A, Bocchino, M, Blasi, F, Spotti, M, Miele, C, Piedepalumbo, F, Barone, I, Baglioni, S, Dodaj, M, Franco, C, Andrani, F, Mangia, A, Mancini, A, Carrozzi, L, Rafanelli, A, Casto, E, Rogliani, P, Ora, J, Carpagnano, G, Di Lecce, V, Tamburrini, M, Papi, A, Contoli, M, Luzzati, R, Zatta, M, Di Bella, S, Caraffa, E, Francisci, D, Tosti, A, Pallotto, C, De Rosa, F, Pecori, A, Franceschini, M, Carlin, M, Orsini, V, Pollastri, E, Rugova, A, Sabbatini, F, Soria, A, Rossi, M, Santantonio, T, Meli, R, Sauro, S, Fedeli, C, Mangini, E, Biolo, G, Nunnari, A, Pietrangelo, A, Corradini, E, Bocchi, D, Boarini, C, Zucchetto, A, Lanini, S, Salton, Francesco, Confalonieri, Paola, Centanni, Stefano, Mondoni, Michele, Petrosillo, Nicola, Bonfanti, Paolo, Lapadula, Giuseppe, Lacedonia, Donato, Voza, Antonio, Carpenè, Nicoletta, Montico, Marcella, Reccardini, Nicolò, Meduri, Gianfranco Umberto, Ruaro, Barbara, MEDEAS Collaborative, Group, and Confalonieri, Marco

Subjects
Pulmonary and Respiratory Medicine, glucocorticoids, Settore MED/10 - Malattie dell'Apparato Respiratorio, pneumonia, COVID-19, glucocorticoid, dexamethasone, ARDS, acute respiratory distress syndrome, methylprednisolone
Abstract

BackgroundDysregulated systemic inflammation is the primary driver of mortality in severe coronavirus disease 2019 (COVID-19) pneumonia. Current guidelines favour a 7–10-day course of any glucocorticoid equivalent to dexamethasone 6 mg daily. A comparative randomised controlled trial (RCT) with a higher dose and a longer duration of intervention was lacking.MethodsWe conducted a multicentre, open-label RCT to investigate methylprednisolone 80 mg as a continuous daily infusion for 8 days followed by slow taperingversusdexamethasone 6 mg once daily for up to 10 days in adult patients with COVID-19 pneumonia requiring oxygen or noninvasive respiratory support. The primary outcome was reduction in 28-day mortality. Secondary outcomes were mechanical ventilation-free days at 28 days, need for intensive care unit (ICU) referral, length of hospitalisation, need for tracheostomy, and changes in C-reactive protein (CRP) levels, arterial oxygen tension/inspiratory oxygen fraction (PaO2/FIO2) ratio and World Health Organization Clinical Progression Scale at days 3, 7 and 14.Results677 randomised patients were included. Findings are reported as methylprednisolone (n=337)versusdexamethasone (n=340). By day 28, there were no significant differences in mortality (35 (10.4%)versus41 (12.1%); p=0.49) nor in median mechanical ventilation-free days (median (interquartile range (IQR)) 23 (14)versus24 (16) days; p=0.49). ICU referral was necessary in 41 (12.2%)versus45 (13.2%) (p=0.68) and tracheostomy in 8 (2.4%)versus9 (2.6%) (p=0.82). Survivors in the methylprednisolone group required a longer median (IQR) hospitalisation (15 (11)versus14 (11) days; p=0.005) and experienced an improvement in CRP levels, but not inPaO2/FIO2ratio, at days 7 and 14. There were no differences in disease progression at the prespecified time-points.ConclusionProlonged, higher dose methylprednisolone did not reduce mortality at 28 days compared with conventional dexamethasone in COVID-19 pneumonia.

Published
2022

14. Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients' data from four randomized trials and trial-level meta-analysis of the updated literature

Author

Meduri, G. Umberto, Bridges, Lisa, Shih, Mei-Chiung, Marik, Paul E., Siemieniuk, Reed A. C., and Kocak, Mehmet

Subjects
Methylprednisolone -- Analysis, Corticosteroids -- Analysis, Mortality -- United Kingdom, Acute respiratory distress syndrome -- Care and treatment -- Patient outcomes, Health care industry
Abstract

Purpose To investigate the effect of prolonged glucocorticoid treatment for patients with acute respiratory distress syndrome (ARDS). Methods We conducted two sets of intention-to-treat analyses: (1) a primary analysis of individual patients' data (IPD) of four randomized controlled trials (RCTs) which investigated methylprednisolone treatment (n = 322) and (2) a trial-level meta-analysis incorporating four additional RCTs which investigated hydrocortisone treatment in early ARDS (n = 297). We standardized definitions to derive outcomes in all datasets. The primary outcome for the IPD analysis was time to achieving unassisted breathing (UAB) by study day 28. Secondary outcomes included mechanical ventilation (MV) and intensive care unit (ICU)-free days, hospital mortality, and time to hospital mortality by day 28. Results By study day 28, compared to the placebo group, the methylprednisolone group had fewer patients who died before achieving UAB (12 vs. 29 %; p < 0.001) and more patients who achieved UAB (80 vs. 50 %; p < 0.001). In the methylprednisolone group, time to achieving UAB was shorter [hazard ratio 2.59, 95 % confidence interval (CI) 1.95-3.43; p < 0.001], and hospital mortality was decreased (20 vs. 33 %; p = 0.006), leading to increased MV (13.3 ± 11.8 vs. 7.6 ± 5.7; p < 0.001) and ICU-free days (10.8 ± 0.71 vs. 6.4 ± 0.85; p < 0.001). In those patients randomized before day 14 of ARDS onset, the trial-level meta-analysis indicated decreased hospital mortality (36 vs. 49 %; risk ratio 0.76, 95 % CI 0.59-0.98, I.sup.2 = 17 %, p = 0.035; moderate certainty). Treatment was not associated with increased risk for infections (risk ratio 0.77, 95 % CI 0.56-1.08, I.sup.2 = 26 %; p = 0.13; moderate certainty). Conclusions Prolonged methylprednisolone treatment accelerates the resolution of ARDS, improving a broad spectrum of interrelated clinical outcomes and decreasing hospital mortality and healthcare utilization., Author(s): G. Umberto Meduri [sup.1], Lisa Bridges [sup.1], Mei-Chiung Shih [sup.2] [sup.3], Paul E. Marik [sup.4], Reed A. C. Siemieniuk [sup.5] [sup.6], Mehmet Kocak [sup.7] Author Affiliations: (1) grid.413847.d, 0000000404204721, [...]

Published
2016
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20. Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia

Author

Meduri, G. Umberto, Shih, Mei-Chiung, Bridges, Lisa, Martin, Thomas J., El-Solh, Ali, Seam, Nitin, Davis-Karim, Anne, Umberger, Reba, Anzueto, Antonio, Sriram, Peruvemba, Lan, Charlie, Restrepo, Marcos I., Guardiola, Juan J., Buck, Teresa, Johnson, David P., Suffredini, Anthony, Bell, W. Andrew, Lin, Julia, Zhao, Lan, Uyeda, Lauren, Nielsen, Lori, Huang, Grant D., Meduri, G. Umberto, Shih, Mei-Chiung, Bridges, Lisa, Martin, Thomas J., El-Solh, Ali, Seam, Nitin, Davis-Karim, Anne, Umberger, Reba, Anzueto, Antonio, Sriram, Peruvemba, Lan, Charlie, Restrepo, Marcos I., Guardiola, Juan J., Buck, Teresa, Johnson, David P., Suffredini, Anthony, Bell, W. Andrew, Lin, Julia, Zhao, Lan, Uyeda, Lauren, Nielsen, Lori, and Huang, Grant D.

Abstract

Purpose: Severe community-acquired pneumonia (CAP) requiring intensive care unit admission is associated with significant acute and long-term morbidity and mortality. We hypothesized that downregulation of systemic and pulmonary inflammation with prolonged low-dose methylprednisolone treatment would accelerate pneumonia resolution and improve clinical outcomes. Methods: This double-blind, randomized, placebo-controlled clinical trial recruited adult patients within 72–96 h of hospital presentation. Patients were randomized in 1:1 ratio; an intravenous 40 mg loading bolus was followed by 40 mg/day through day 7 and progressive tapering during the 20-day treatment course. Randomization was stratified by site and need for mechanical ventilation (MV) at the time of randomization. Outcomes included a primary endpoint of 60-day all-cause mortality and secondary endpoints of morbidity and mortality up to 1 year of follow-up. Results: Between January 2012 and April 2016, 586 patients from 42 Veterans Affairs Medical Centers were randomized, short of the 1420 target sample size because of low recruitment. 584 patients were included in the analysis. There was no significant difference in 60-day mortality between the methylprednisolone and placebo arms (16% vs. 18%; adjusted odds ratio 0.90, 95% CI 0.57–1.40). There were no significant differences in secondary outcomes or complications. Conclusions: In patients with severe CAP, prolonged low-dose methylprednisolone treatment did not significantly reduce 60-day mortality. Treatment was not associated with increased complications.

Published
2022

30. Hormonal Receptors in the Genital Tract

Author

Chauchereau, A., Mantel, A., Delabre, K., Misrahi, M., Lescop, P., Perrot-Applanat, M., Loosfelt, H., Hai, M. T. Vu, Ghinea, N., Meduri, G., Savouret, J.-F., Milgrom, E., Stock, Günter, editor, Habenicht, Ursula-F., editor, Verhoeven, G., editor, and Habenicht, U.-F., editor

Published
1994
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36. Corticosteroids in the treatment of severe sepsis and septic shock in adults

Author

Annane, Djillali, Bellissant, Eric, Bollaert, Pierre-Edouard, Briegel, Josef, Confalonieri, Marco, De Gaudio, Raffaele, Keh, Didier, Kupfer, Yizhak, Oppert, Michael, and Meduri, G. Umberto

Subjects
Corticosteroids -- Usage, Corticosteroids -- Complications and side effects, Sepsis -- Care and treatment, Mortality -- United States, Mortality -- Control, Septic shock -- Care and treatment
Abstract

A study was conducted to evaluate the benefits and risks associated with the use of corticosteroids as a form of treatment for severe and septic shock among adults. Results indicated that there is no clear indication of benefit in reduction of mortality after use of such medicines, however, of late, low-dosage has been recommended for more beneficial results.

Published
2009

49. Prolonged Low-Dose Methylprednisolone in Patients With Severe COVID-19 Pneumonia

Author

Salton, Francesco, primary, Confalonieri, Paola, additional, Meduri, G Umberto, additional, Santus, Pierachille, additional, Harari, Sergio, additional, Scala, Raffaele, additional, Lanini, Simone, additional, Vertui, Valentina, additional, Oggionni, Tiberio, additional, Caminati, Antonella, additional, Patruno, Vincenzo, additional, Tamburrini, Mario, additional, Scartabellati, Alessandro, additional, Parati, Mara, additional, Villani, Massimiliano, additional, Radovanovic, Dejan, additional, Tomassetti, Sara, additional, Ravaglia, Claudia, additional, Poletti, Venerino, additional, Vianello, Andrea, additional, Gaccione, Anna Talia, additional, Guidelli, Luca, additional, Raccanelli, Rita, additional, Lucernoni, Paolo, additional, Lacedonia, Donato, additional, Foschino Barbaro, Maria Pia, additional, Centanni, Stefano, additional, Mondoni, Michele, additional, Davì, Matteo, additional, Fantin, Alberto, additional, Cao, Xueyuan, additional, Torelli, Lucio, additional, Zucchetto, Antonella, additional, Montico, Marcella, additional, Casarin, Annalisa, additional, Romagnoli, Micaela, additional, Gasparini, Stefano, additional, Bonifazi, Martina, additional, D’Agaro, Pierlanfranco, additional, Marcello, Alessandro, additional, Licastro, Danilo, additional, Ruaro, Barbara, additional, Volpe, Maria Concetta, additional, Umberger, Reba, additional, and Confalonieri, Marco, additional

Published
2020
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