Evidence map›Paper›PMID 33150472›Full record

SynthesisIntensive care medicine2020

Pharmacological principles guiding prolonged glucocorticoid treatment in ARDS.

Gianfranco Umberto Meduri, Djillali Annane, Marco Confalonieri, George P Chrousos, Bram Rochwerg, Amanda Busby, Barbara Ruaro, Bernd Meibohm

3 registry-linked trialsOpen access · bronzeAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 87 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
87citing papers in PubMed, 8 pooled it
10.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04636671 phase3completednot on this mapstarted 2021, after this paper: background citation

Randomized Controlled Trial of Methylprednisolone Versus Dexamethasone in COVID-19 Pneumonia (MEDEAS Trial)

TypeinterventionalSponsorUniversity of TriesteRan2021 to 2022Enrolled690ConditionsCovid19, Viral Pneumonia Human Coronavirus, Severe Acute Respiratory SyndromeArmsMethylprednisolone, Dexamethasone
NCT04663555 phase4completednot on this mapstarted 2021, after this paper: background citation

Effect of Dexamethasone in Patients With ARDS and COVID-19 - Prospective, Multi-centre, Open-label, Parallel-group, Randomized Controlled Trial (REMED Trial)

TypeinterventionalSponsorBrno University HospitalRan2021 to 2023Enrolled235ConditionsCovid19, ARDSArmsDexamethasone
NCT05658692 phase4unknown statusnot on this mapstarted 2022, after this paper: background citation

Platform Adaptive Embedded Trial for Acute Respiratory Distress Syndrome

TypeinterventionalSponsorSecond Affiliated Hospital, Zhejiang University, School of MedicineRan2022 to 2023Enrolled1,000ConditionsAcute Respiratory Distress SyndromeArmsprotective ventilation, prone position ventilation, glucocorticoid therapy, restrictive fluid resuscitation, Thymosin Alpha
3 · Its place in the literature

Who cites it

87 citing papers in PubMed, 8 syntheses or guidelines pooled it, 138 citations in OpenAlex.

  1. Pooled it
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  5. Pooled it
  6. Pooled it
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  9. Trial
  10. Prolonged higher dose methylprednisoloneThe European respiratory journal · 2023
    Trial
  11. Review
  12. Review
  13. ARDS and corticosteroids: beyond COVID-19.Pneumonia (Nathan Qld.) · 2026
    Review
  14. Review
  15. Glucocorticoid Treatment in Community-Acquired Pneumonia.Seminars in respiratory and critical care medicine · 2026
    Review
  16. Article
  17. Article
  18. Review
  19. Article
  20. Article

27 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 6 countries.

Gianfranco Umberto MeduriMemphis Veterans Affairs Medical Center Research Service, Departments of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. gmeduri@uthsc.edu.ORCID 0000-0002-4848-8928
Djillali AnnaneDepartment of Critical Care, Raymond Poincaré Hospital (AP-HP), Laboratory Infection and Inflammation, U1173, Faculty of Health Science Simone Veil, University of Versailles SQY, University Paris Saclay, INSERM, FHU SEPSIS, RHU RECORDS, Versailles, France.
Marco ConfalonieriPulmonology Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy.
George P ChrousosUniversity Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Bram RochwergDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Amanda BusbyHealth Research Methods Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
Barbara RuaroPulmonology Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy.
Bernd MeibohmDepartment of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, USA.
University of Tennessee Health Science Center · USUniversity of Trieste · ITImpact · CAInserm · FRNational and Kapodistrian University of Athens · GRUniversity of Hertfordshire · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Current literature addressing the pharmacological principles guiding glucocorticoid (GC) administration in ARDS is scant. This paucity of information may have led to the heterogeneity of treatment protocols and misinterpretation of available findings. GCs are agonist compounds that bind to the GC receptor (GR) producing a pharmacological response. Clinical efficacy depends on the magnitude and duration of exposure to GR. We updated the meta-analysis of randomized trials investigating GC treatment in ARDS, focusing on treatment protocols and response. We synthesized the current literature on the role of the GR in GC therapy including genomic and non-genomic effects, and integrated current clinical pharmacology knowledge of various GCs, including hydrocortisone, methylprednisolone and dexamethasone. This review addresses the role dosage, timing of initiation, mode of administration, duration, and tapering play in achieving optimal response to GC therapy in ARDS. Based on RCTs' findings, GC plasma concentration-time profiles, and pharmacodynamic studies, optimal results are most likely achievable with early intervention, an initial bolus dose to achieve close to maximal GRα saturation, followed by a continuous infusion to maintain high levels of response throughout the treatment period. In addition, patients receiving similar GC doses may experience substantial between-patient variability in plasma concentrations affecting clinical response. GC should be dose-adjusted and administered for a duration targeting clinical and laboratory improvement, followed by dose-tapering to achieve gradual recovery of the suppressed hypothalamic-pituitary-adrenal (HPA) axis. These findings have practical clinical relevance. Future RCTs should consider these pharmacological principles in the study design and interpretation of findings.

Indexed as

GlucocorticoidsRespiratory Distress SyndromeHumansHypothalamo-Hypophyseal SystemMethylprednisolonePituitary-Adrenal SystemGlucocorticoidsMethylprednisoloneAcute respiratory distress syndromeDurationGlucocorticoidGlucocorticoid receptorPharmacodynamicRandomized trialReceptor affinity

Identifiers

PMID33150472
PMCPMC7641258
OpenAlexW3097806887

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.