Community Acquired Pneumonia: Evaluation of Corticosteroids in Coronavirus Disease - CAPE COVID

Sep 08, 2020
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
French Ministry of Health
Date Published:
09/02/2020
Date Updated:
09/08/2020
Original Posted Date:
09/08/2020
References

Contribution To Literature:

The CAPE COVID trial failed to show that low-dose corticosteroids improved outcomes among critically ill patients with COVID-19 infection.

Description:

The goal of the trial was to evaluate low-dose corticosteroids compared with placebo among patients with coronavirus disease 2019 (COVID-19) infection and acute respiratory failure.

Study Design

  • Randomized
  • Parallel
  • Placebo
  • Stratified

Eligible patients were randomized to low-dose hydrocortisone (n = 76) versus placebo (n = 73).

Hydrocortisone was given intravenously at 200 mg per day until day 7, then decreased to 100 mg per day for 4 days, then 50 mg per day for 3 days, for a total of 14 days.

  • Total number of enrollees: 149
  • Duration of follow-up: 21 days
  • Mean patient age: 62 years
  • Percentage female: 29%
  • Percentage with diabetes: 17%

Inclusion criteria:

  • Critically ill patients with COVID-19 infection
  • Acute respiratory failure

Principal Findings:

The primary outcome, treatment failure at 21 days, occurred in 42.1% of the hydrocortisone group compared with 50.7% of the placebo group (p = 0.29). Treatment failure was defined as death, mechanical ventilation, or high-flow oxygen therapy.

Secondary outcomes:

  • Endotracheal intubation: 50.0% of the hydrocortisone group compared with 75.0% of the placebo group (p = nonsignificant)
  • Mortality: 14.7% of the hydrocortisone group compared with 27.4% of the placebo group (p = 0.06)
  • Nosocomial infection: 37.7% of the hydrocortisone group compared with 41.4% of the placebo group (p = 0.42)

Interpretation:

This trial was terminated early after the release of the dexamethasone trial, which found benefit for that medication among critically ill COVID-19 patients. In the current trial, among patients with acute respiratory failure due to COVID-19 infection, low-dose hydrocortisone was not beneficial. In this underpowered trial, low-dose hydrocortisone did not reduce the incidence of death, mechanical ventilation, or high-flow oxygen therapy.

References:

Dequin PF, Heming N, Meziani F, et al. Effect of Hydrocortisone on 21-Day Mortality or Respiratory Support Among Critically Ill Patients With COVID-19: A Randomized Clinical Trial. JAMA 2020;Sep 2:[Epub ahead of print].

Editorial: Prescott HC, Rice TW. Corticosteroids in COVID-19 ARDS: Evidence and Hope During the Pandemic. JAMA 2020;Sep 2:[Epub ahead of print].

Clinical Topics: COVID-19 Hub, Prevention

Keywords: Coronavirus, Coronavirus Infections, COVID-19, Critical Illness, Cross Infection, Hydrocortisone, Intubation, Intratracheal, Oxygen Inhalation Therapy, Pneumonia, Primary Prevention, Respiration, Artificial, severe acute respiratory syndrome coronavirus 2, Treatment Outcome


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