High-Dose Steroids Fail Against Hantavirus Cardiopulmonary Syndrome

June 24, 2013

By Will Boggs, MD

NEW YORK (Reuters Health) Jun 24 - High-dose IV methylprednisolone is not helpful against hantavirus cardiopulmonary syndrome (HCPS), researchers from Chile report.

"We were disappointed by the lack of efficacy," Dr. Francisca Valdivieso from Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile, told Reuters Health. "However, there are competing theories regarding the pathogenesis of the cardiopulmonary phase of HCPS, and the mediators are probably complex."

Dr. Valdivieso and colleagues tested IV methylprednisolone in a phase II randomized trial in 60 patients with HCPS in the cardiopulmonary phase.

Similar proportions died in the methylprednisolone group (8/30, 27%) and the placebo group (12/30, 40%; p=0.41).

Mean numbers of days in the hospital, in the ICU, on inotropic support, and on mechanical ventilation were similar between the groups, as were rates of shock and intubation. Only the sequential organ failure assessment (SOFA) score at entry independently predicted survival, the authors reported online June 19 in Clinical Infectious Diseases.

Significantly more patients in the placebo group (25/34, 74%) than in the methylprednisolone group (14/32, 44%) had at least one serious adverse event, although grade 2 or 3 hyperglycemia was more common with steroid therapy.

Hantavirus (Andes virus, ANDV) RNA was detected in most patients in both treatment groups through day 14, and all surviving patients were negative by day 180. Viral load at admission did not differ between patients who developed shock or required mechanical ventilation and those who did not, or between patients who died versus those who survived.

"High-dose methylprednisolone treatment does not offer clinical benefit to patients and should not be used for treatment of hantavirus cardiopulmonary syndrome," Dr. Valdivieso advises.

"At the same time," she added, "with this trial we were able to learn about the natural history and prognostic factors of the disease."

"Patients that develop cardiogenic shock have the higher case fatality rate," Dr. Valdivieso continued. "This reinforces the need for clinical care that anticipates complications, which include(s) clinical awareness of the disease and laboratory tests for early diagnosis, early transfer to an intensive care unit for monitoring and treatment, and appropriate management of respiratory failure and shock."

"Additional research is needed to identify and evaluate interventions that reduce the risk of respiratory failure, shock and death," Dr. Valdivieso said. "Groups are searching for compounds that prevent vascular leakage in hantavirus-infected vascular endothelial cells, and promising therapeutic options are being carried into animal models of lethal infection."

"The announcement earlier this month (at the hantavirus Beijing meeting) of the successful development of a lethal non-human primate model of HCPS by a group from the NIH laboratory in Hamilton, Montana, should provide an additional model for evaluation of therapeutic options," Dr. Valdivieso added.

SOURCE: http://bit.ly/11WEbig

Clin Infect Dis 2013.


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