Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients

Lee, Nelson; Allen Chan, K.C.; Hui, David S.; Ng, Enders K.O.; Wu, Alan; Chiu, Rossa W.K.; Wong, Vincent W.S.; Chan, Paul K.S.; Wong, K.T.; Wong, Eric; Cockram, C.S.; Tam, John S.; Sung, Joseph J.Y.; Lo, Y.M. Dennis

BACKGROUND: The effect of corticosteroid treatment on the viral load of Severe Acute Respiratory Syndrome (SARS) patients is unknown. OBJECTIVE: To compare the plasma SARS-CoV RNA concentrations in ribavirin-treated patients who received early hydrocortisone therapy with those who received placebo. STUDY DESIGN: Serial plasma SARS-CoV RNA concentrations measured in the setting of a prospective, randomized double-blinded, placebo-controlled trial designed to assess the efficacy of “early” (<7 days of illness) hydrocortisone use in previously healthy SARS patients were analyzed. SARS-CoV RNA was quantified using a one-step real-time RT-PCR assay targeting the nucleocapsid gene. RESULTS: Among 16 non-ICU cases, SARS-CoV RNA was detected in plasma since day 3–4 after fever onset; viral concentration peaked in the first week, which then rapidly declined in the second week of illness. On days 8, 12, 16, and 20, the cumulative proportion of patients with undetectable virus in plasma was 31%, 69%, 92%, and 100%, respectively. Plasma SARS-CoV RNA concentrations in the second and third week of illness were significantly higher in patients who received initial hydrocortisone treatment (n = 9), as compared to those who received placebo (n = 7)(AUC; Mann–Whitney, P = 0.023). The median time for SARS-CoV to become undetectable in plasma was 12 days (11–20 days) versus 8 days (8–15 days), respectively. CONCLUSION: Our findings suggested “early” corticosteroid treatment was associated with a higher subsequent plasma viral load.