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Response to: ‘Glucocorticoid-induced relapse of COVID-19 in a patient with sarcoidosis’ by Györfi et al
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  1. Milena Gianfrancesco1,
  2. Kimme L Hyrich2,
  3. Jinoos Yazdany3,
  4. Pedro M Machado4,5,
  5. Philip C Robinson6,7
  1. 1 Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
  2. 2 Centre for epidemiology Versus arthritis, University of Manchester, Manchester, UK
  3. 3 Medicine/Rheumatology, University of California, San Francisco, California, USA
  4. 4 MRC Centre for Neuromuscular Diseases, University College London, London, UK
  5. 5 Rheumatology, University College London Centre for Rheumatology, London, UK
  6. 6 Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
  7. 7 Metro North Hospital & Health Service, Royal Brisbane and Woman’s Hospital Health Service District, Herston, Queensland, Australia
  1. Correspondence to Dr Philip C Robinson, Faculty of Medicine, The University of Queensland, Herston, QLD 4072, Australia; philip.robinson{at}uq.edu.au

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We thank Györfi et al for their correspondence.1 The case they present demonstrates a potentially important point that was reported in our manuscript2: the effect of systemic glucocorticoids may worsen outcomes in patients with rheumatic disease. However, as has been highlighted recently by the results of the Randomised Evaluation of COVid-19 thERapY (RECOVERY) trial, systemic glucocorticoids may have a role to play in treating COVID-19.3 Noteworthy, in the RECOVERY trial, dexamethasone (6 mg daily for 10 days) only reduced deaths in the patients that were ventilated (one-third reduction) or receiving oxygen (one-fifth reduction) but no benefit was seen among those patients who did not require respiratory support; moreover, the trial did not study patients outside the hospital setting. Further, differences in outcomes between different glucocorticoid preparations, administration route, dose and the timing of dosing, and pre-existing use compared with use introduced specifically for the treatment of COVID-19 have yet to be explored. The point made about primary infection, relapse and secondary infection requires more in-depth study including into the role of asymptomatic positive nucleic acid swabs for severe acute respiratory syndrome coronavirus 2 after recovery from a primary infection. Our study was not designed to address this question and information about relapse/secondary infection is not captured.

Although we did not examine patients with sarcoidosis separately in the report, we appreciate the opportunity to share results on this subset of patients. There were 41 patients with sarcoidosis in the registry,2 for whom hospitalisation status was only provided in 34. The majority were not on prednisone-equivalent glucocorticoids (n=23), 13 patients were on 1–9 mg/day and 5 patients on ≥10 mg/day. There were no significant differences in hospitalisation status based on their underlying glucocorticoid dose when we examined the patients with sarcoidosis only (p=0.43), although it is important to note that we are likely underpowered at this time to make robust comparisons among groups We plan to report more detailed analyses of patients with sarcoidosis when numbers increase.

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Footnotes

  • Handling editor Josef S Smolen

  • Twitter @pedrommcmachado, @philipcrobinson

  • Contributors All authors drafted the work and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MG reports grants from National Institutes of Health, NIAMS, outside the submitted work. KLH reports she has received speaker’s fees from Abbvie and grant income from BMS, UCB and Pfizer, all unrelated to this manuscript. KLH is also supported by the NIHR Manchester Biomedical Research Centre. JY reports personal fees from Astra Zeneca, personal fees from Eli Lilly, grants from Pfizer, outside the submitted work. PMM reports personal fees from Abbvie, personal fees from Eli Lilly, personal fees from Novartis, personal fees from UCB, outside the submitted work. PCR reports personal fees from Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, UCB Pharma and non-financial support from BMS and Roche outside the submitted work.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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