Methylprednisolone is Associated with Viral RNA Shedding in COVID-19 Patients from a Multicenter Study

Objective: To assess whether methylprednisolone (corticosteroids) affect viral RNA shedding in patients with COVID-19.Methods: 273 patients were divided into seven groups: corticosteroid group and non-corticosteroid group, early corticosteroid group and delayed group, non-severe patients and severe patients. In non-severe patients, corticosteroid and non-corticosteroid therapy, early corticosteroid and delayed corticosteroid therapy were compared. The grouping of severe patients was the same as that of non-severe patients. The primary end-point was viral RNA shedding cessation.Results: Corticosteroids were a risk factor for prolonged viral RNA shedding (OR 2.040, 95% CI 1.034-4.026, P=0.040). However, early corticosteroid therapy was a positive factor for viral RNA shedding (HR 0.051, 95% CI 0.004-0.589, P=0.017). In the corticosteroid group, a meaningless difference was observed between non-severe patients and severe patients. In non-severe patients, differences between groups were not observed. In severe patients, corticosteroids did not lead to prolonged viral shedding. In addition, early corticosteroid therapy was associated with faster cessation of viral RNA shedding than delayed therapy (19.0 vs. 26.5 days, P=0.013).Conclusions: Corticosteroids may prolong viral RNA shedding in patients with COVID-19. Nevertheless, for patients who need corticosteroid therapy, the early administration of corticosteroids might confer a viral RNA shedding advantage, especially among severe patients.