(39) Comparative Effectiveness of Different Corticosteroid Regimens in Patients with Acute Respiratory Distress Syndrome

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 713

Presenting Author(s)

Muhammed Rashid, MPharm, BPharm
– Research Scholar, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Manipal, Udupi, Karnataka, India

Co-Author(s)

Sreedharan Nair, MPharm, PhD, PhD
– Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
Girish Thunga
– Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Manipal, Karnataka, India
Vijayanarayana Kunhikatta, MPharm, PhD
– Associate Professor, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Manipal, Karnataka, India
Vishal Shanbhag
– Department of Critical Care, Kasturba Hospital, Manipal, Karnataka, India
Viji Chandran
– Research scholar, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
Asha K. Rajan, PharmD
– Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education , CHENNAI, Tamil Nadu, India
Raviaraja Acharya
– Professor & HOD, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Manipal, Karnataka, India

Background: The optimal corticosteroid treatment strategy for management of Acute Respiratory Distress Syndrome (ARDS) is still uncertain.

Objectives: We aimed to analyze the comparative effectiveness of different corticosteroid regimens in ARDS patients.

Methods: A total of 713 records of patients diagnosed with ARDS were reviewed retrospectively during a five-year period. Among included participants, 403 did not receive steroid treatment, 147 were given IV steroids and 158 received non-IV steroids treatment. Based on methylprednisolone equivalency, IV Steroid participants were categorized into four groups, (i) low dose for shorter duration (LDSD; ≤80mg for ≤14 days; n=88);(ii) low dose for longer duration (LDLD; ≤80mg for >14 days; n=34);(iii) high dose for shorter duration (HDSD; >80mg for ≤14 days; n=23); and (iv) high dose for longer duration (HDLD; >80mg for >14 days; n=2). Logistics and linear regression were used to analyze the categorical and continuous outcomes.

Results: The LDLD treatment group had a significantly higher recovery rate(OR:4.83; 95%CI:1.71-13.64;p=0.002) compared to the other group [LDSD:OR:1; p=Ref; HDSD:OR:1.29; p=0.795; HDLD:OR:0.00; p=0.278]. Though the LDLD group had better outcomes in terms of ventilation-free days (8.3/10.6/8.6/11.5), ICU-free days (4.6/6.6/4.5/9.5), and oxygenation-free days (10.5/13.5/10.5/12.5) than the other groups, the difference was not statistically significant (p>0.05). The time of administration in patients treated with LDLD was compared, and those who received it within 24-48 hours (100%) and 48-72 hours (66.7%) of hospital admission or ARDS diagnosis recovered better than those who received it before 24 hours (31.8%) and after 72 hours (50%) of hospital admission or ARDS diagnosis.

Conclusions: We recommend a practice-based steroid regimen of low dose ≤80 mg methylprednisolone or equivalent dose for >14 days, administered between 24-72 hours, as an optimum steroid regimen for the management of ARDS.