Low-Dose Prednisolone Shortened Hospital Stays for Patients With COVID-19

Investigators in Iran explored the effectiveness of low-dose prednisolone therapy in avoiding adverse outcomes in patients with moderate to severe COVID-19.

In patients with moderate to severe COVID-19, using a therapeutic regimen based on low-dose prednisolone was superior to other regimens in shortening an individual’s hospital length of stay (LOS), according to results of an analysis published in Respiratory Research.

Investigators conducted a multicenter, randomized, open-label, 3-arm trial in 6 centers in Iran between April and August in 2020 to evaluate the efficacy of low-dose corticosteroid therapy in patients with moderate to severe SARS-CoV-2 infection. Patients were randomized in a 1:1:1 ratio to 1 of 3 treatment regimens. Patients in the first group (regimen I) received hydroxychloroquine stat, prednisolone (25 mg daily for 5 days, then gradual tapering to 5 mg per week after discharge), azithromycin, and naproxen (n=120). The second group (regimen II) comprised individuals treated with hydroxychloroquine stat, azithromycin, and naproxen (n=116). The third group of patients (regimen III) included those who received hydroxychloroquine stat and lopinavir/ritonavir (n=116).

The primary study outcome was admission to the intensive care unit (ICU). Secondary outcomes included intubation, in-hospital mortality, time to clinical recovery, and hospital LOS. The mean LOS in patients who received prednisolone was significantly shorter in the modified intention-to-treat (ITT) population (5.5 days) and in the per-protocol (PP) population (4.4 days), compared with 6.4 days in the modified ITT population and 5.8 days in the PP population among those treated with lopinavir/ritonavir (P =.028 and P =.007, respectively).

No significant difference was observed in the number of ICU admissions, number of deaths, or need for mechanical ventilation in the modified ITT and the PP populations between those treated with prednisolone and those who received lopinavir/ritonavir. The outcomes, however, were better in the group treated with prednisolone than in the other groups.

Additionally, the discharge experience was similar with the 3 regimens among the modified ITT and the PP populations (log-rank test: P =.335 and P =.055, respectively). Further, no significant differences were reported with respect to time to clinical recovery, which was similar with regimen I, regimen II, and regimen III among those in the modified ITT population and those in the PP population (P =.291 and P =.098, respectively). Treatment with azithromycin alone was not associated with clinical or statistical differences in any of the outcomes evaluated when compared with treatment with lopinavir/ritonavir.

The researchers concluded that the steroid-sparing effect shown in the current study may be used to increase the effectiveness of corticosteroids in the management of patients with diabetes by decreasing the dosage.


Ghanei M, Solaymani-Dodaran M, Qazvini A, et al. The efficacy of corticosteroids therapy in patients with moderate to severe SARS-CoV-2 infection: a multicenter, randomized, open-label trial. Respir Res. 2021;22(1):245. doi:10.1186/s12931-021-01833-6