From the Guidelines
The Hong Kong protocol for SARS treatment involves the use of high-dose steroids, such as methylprednisolone, in combination with other therapies, but its effectiveness is still debated and not widely recommended due to concerns about the use of high-dose steroids 1. The protocol has been studied in various settings, including a retrospective analysis of Hong Kong patients who received ribavirin in combination with different steroid regimens, which showed that patients who received initial high-dose pulsed methylprednisolone intravenously had less oxygen requirement and better radiological improvement than those who received non-pulse steroid therapy 1. Some key points to consider when evaluating the Hong Kong protocol include:
- The use of high-dose steroids has been anecdotally reported to contribute to a decrease in fever and need for oxygen supplementation 1
- A study from Guangzhou, China suggested that early administration of high-dose steroids together with CPAP ventilation is associated with lower mortality, but these findings are not based on adequately controlled data 1
- The overall mortality rate, and requirement for mechanical ventilation or admission to the intensive care unit was the same for both pulse and non-pulse steroid regimens 1 It is essential to weigh the potential benefits and risks of the Hong Kong protocol, considering the limited and equivocal evidence available, and prioritize caution in real-life clinical practice 1.
From the Research
Hong Kong Protocol
- The Hong Kong protocol is related to the treatment of COVID-19, specifically the use of antiviral drugs such as nirmatrelvir-ritonavir and molnupiravir 2, 3.
- Studies have shown that viral burden rebound can occur in patients receiving these antiviral treatments, but the incidence of rebound does not differ significantly across treatment groups 2.
- Factors associated with increased odds of viral burden rebound include immunocompromised status, high comorbidity burden, and concomitant use of corticosteroids 2.
- The effectiveness of vaccines and antiviral drugs in preventing severe and fatal COVID-19 has been studied in Hong Kong, with results showing that both oral antiviral drugs and vaccines are associated with lower risks for all-cause mortality and progression to serious/critical/fatal conditions 3.
Antiviral Treatment
- Combination antiviral therapy has been studied as a potential treatment for influenza, with some studies showing that combining antivirals such as oseltamivir, amantadine, and ribavirin may be more effective than monotherapy 4, 5, 6.
- However, the clinical benefit of combination antiviral therapy for influenza is still unclear, with some studies showing no significant improvement in clinical outcomes despite a decrease in viral shedding 6.
- The safety and pharmacokinetics of combination antiviral therapy have been studied, with results showing that the therapy can be administered safely in immunocompromised patients 4.