Can steroids reverse the severe COVID‐19 induced “cytokine storm”?

Kolilekas, Lykourgos; Loverdos, Konstantinos; Giannakaki, Styliani; Vlassi, Lamprini; Levounets, Anastasia; Ζervas, Εleftherios; Gaga, Mina

doi:10.1002/jmv.26165

Cited by 75 publications

(67 citation statements)

References 14 publications

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“…Median (IQR) time from onset of symptoms to admission, to ARDS, and to first dose of steroids were 7 (4-9), 8 (6-11), and 10 (7-14) days, respectively, with no differences between both groups. Patients were followed for a median (IQR) of 21 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) days. Baseline demographics, clinical data, and radiological and laboratory findings are shown in Table 1.…”

Section: Patient Characteristicsmentioning

confidence: 99%

High versus standard doses of corticosteroids in severe COVID-19: a retrospective cohort study

Monreal

Maza

Natera‐Villalba

et al. 2020

Eur J Clin Microbiol Infect Dis

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Despite the increasing evidence of the benefit of corticosteroids for the treatment of moderate-severe coronavirus disease 2019 (COVID-19) patients, no data are available about the potential role of high doses of steroids for these patients. We evaluated the mortality, the risk of need for mechanical ventilation (MV), or death and the risk of developing a severe acute respiratory distress syndrome (ARDS) between high (HD) and standard doses (SD) among patients with a severe COVID-19. All consecutive confirmed COVID-19 patients admitted to a single center were selected, including those treated with steroids and an ARDS. Patients were allocated to the HD (≥ 250 mg/day of methylprednisolone) of corticosteroids or the SD (≤ 1.5 mg/kg/day of methylprednisolone) at discretion of treating physician. Five hundred seventy-three patients were included: 428 (74.7%) men, with a median (IQR) age of 64 (54-73) years. In the HD group, a worse baseline respiratory situation was observed and male gender, older age, and comorbidities were significantly more common. After adjusting by baseline characteristics, HDs were associated with a higher mortality than SD (adjusted OR 2.46, 95% CI 1.59-3.81, p < 0.001) and with an increased risk of needing MV or death (adjusted OR 2.35, p = 0.001). Conversely, the risk of developing a severe ARDS was similar between groups. Interaction analysis showed that HD increased mortality exclusively in elderly patients. Our real-world experience advises against exceeding 1-1.5 mg/kg/day of corticosteroids for severe COVID-19 with an ARDS, especially in older subjects. This reinforces the rationale of modulating rather than suppressing immune responses in these patients.

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Section: Patient Characteristicsmentioning

confidence: 99%

High versus standard doses of corticosteroids in severe COVID-19: a retrospective cohort study

Monreal

Maza

Natera‐Villalba

et al. 2020

Eur J Clin Microbiol Infect Dis

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“…It may be that the corticosteroid benefit involves low levels of type I and III interferons juxtaposed to elevated chemokines and high expressions of IL-6. Reduced initial innate antiviral defenses allow the virus to multiply, followed after a few days by relatively excess inflammatory cytokine production, allowing for steroids to reduce the latter in the early features of COVID-19, before appreciable pneumonia has occurred [ 37 ]. Hydroxychloroquine has a number of suggested beneficial actions for early COVID-19, not least of which is its non-immunosuppressive immunomodulatory activity [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Risk of hospitalization for Covid-19 outpatients treated with various drug regimens in Brazil: Comparative analysis

Fonseca

Sousa

Wolkoff³

et al. 2020

Travel Medicine and Infectious Disease

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Background For the past few months, HMOs have faced crowded emergency rooms and insufficient hospital and intensive-care-unit beds, all from the worst pandemic of this century, COVID-19. Methods In a large HMO in Brazil, our approach was to allow treating physicians to prescribe antiviral medications immediately at presentation, and prednisone starting on day-6 of symptoms to treat pulmonary inflammation. We implemented this COVID-19 protocol for outpatients and studied 717 consecutive SARS-CoV-2-positive patients age 40 years or older presenting at our emergency rooms. Results Use of hydroxychloroquine (HCQ), prednisone or both significantly reduced hospitalization risk by 50–60%. Ivermectin, azithromycin and oseltamivir did not substantially reduce risk further. Hospitalization risk was doubled for people with type-2 diabetes or obesity, increased by two-thirds for people with heart disease, and by 75% for each decade of age over age 40. Similar magnitudes of reduced risk with HCQ and prednisone use were seen for mortality risk, though were not significant because of only 11 deaths among the 717 patients. No cardiac arrhythmias requiring medication termination were observed for any of the medications. Conclusions This work adds to the growing literature of studies that have found substantial benefit for use of HCQ combined with other agents in the early outpatient treatment of COVID-19, and adds the possibility of steroid use to enhance treatment efficacy.

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“…Scientists have ambiguous opinions on corticosteroid therapy that affect COVID-19 pneumonia. A variety of articles claims it bene ts or stays neutrality [21][22][23][24][25][26][27], meanwhile, there is also evidence that corticosteroid treatment is associated with high mortality and it is recommended not to use corticosteroid [28][29][30][31]. Given that above studies did not exclude endogenous problems well and COVID-19 is still in the epidemic, and based on con icting perspectives, we aimed at severe and critical patients with COVID-19 pneumonia and balance patient conditions before corticosteroid treatment by PS full matching to perform a more robust result whether corticosteroid works on severe and critical patients with COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Corticosteroids treatment in severe patients with COVID-19: a propensity score matching study

Chen

Song

Wang

et al. 2020

Preprint

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Objectives Explore the efficacy of corticosteroid treatment in patients with severe COVID-19 pneumonia and the association between corticosteroid use and patient mortality. Methods A retrospective investigation was made on the medical records of the patients with severe and critical patients with COVID-19 pneumonia from January to February 2020. First, the patients who received corticosteroid treatment were compared with patients without given corticosteroid treatment. Then a propensity score matching method was used to control confounding factors. Cox survival regression analysis was used to evaluate the effect of corticosteroid therapy on the mortality of severe and critical patients with COVID-19. Results A total of 371 severe and critical patients were enrolled in our statistics. 209 patients were treated with corticosteroid therapy. Most of them were treated with methylprednisolone (197[94.3%]). The median corticosteroid therapy was applied 3(IQR 2–6) days after admission, 13(IQR 10–17) days after symptoms appeared. Temperature on admission(OR = 1.255,[95%CI 1.021–1.547],p = 0.032), ventilation(OR = 1.926,[95%CI 1.148–3.269],p = 0.014) and ICU admission(OR = 3.713, [95%CI 1.776–8.277],p < 0.001) were significantly associated with corticosteroids use. After PS matching, the cox regression survival analysis showed that corticosteroid use was significantly associated with a lower mortality rate (HR = 0.592, [95%CI 0.406–0.862], p = 0.006). Conclusion Corticosteroid therapy use in severe and critical patients with COVID-19 pneumonia leads to lower mortality but may cause other side effects. Corticosteroid therapy should be used carefully.

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Can steroids reverse the severe COVID‐19 induced “cytokine storm”?

Cited by 75 publications

References 14 publications

High versus standard doses of corticosteroids in severe COVID-19: a retrospective cohort study

High versus standard doses of corticosteroids in severe COVID-19: a retrospective cohort study

Risk of hospitalization for Covid-19 outpatients treated with various drug regimens in Brazil: Comparative analysis

Corticosteroids treatment in severe patients with COVID-19: a propensity score matching study

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