Clinical efficacy of glucocorticoid on the treatment of patients with COVID-19 pneumonia: A single-center experience

Hu, Yan; Wang, Tingping; Hu, Zhimin; Wang, Xuan; Zhengbin, Zhang; Li, Li; Peng, Peng

doi:10.1016/j.biopha.2020.110529

Cited by 23 publications

(24 citation statements)

References 22 publications

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“…When a patient is faced with a serious stress like COVID-19, it is difficult for doctors to avoid using glucocorticoids [16]. Therefore, doctors in various countries initiated a number of clinical trials to assess the efficacy of glucocorticoids [17][18][19][20][21][22][23]. On 23 January The results of clinical trials on the benefits of using glucocorticoids in the treatment of patients with COVID-19 were gradually published in mid-2020.…”

Section: Glucocorticoids and Covid-19 Therapymentioning

confidence: 99%

Glucocorticoids are double-edged sword in the treatment of COVID-19 and cancers

Yang¹,

Yu²

2021

Int. J. Biol. Sci.

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Glucocorticoids are important steroid hormones. As an outstanding scientific discovery, the scientist who discovered glucocorticoids was awarded the Nobel Prize in Physiology and Medicine in 1950. Cortisone (hydrocortisone) is a natural glucocorticoid, which is secreted with circadian rhythm by the cortical cells of adrenal glands. Physiologically, about 10-20 mg of hydrocortisone are secreted each day for maintaining homeostasis. Since the biological half-life of natural glucocorticoid is short, scientists developed various synthetic glucocorticoids including prednisone, prednisolone, methylprednisolone, triamcinolone, dexamethasone, betamethasone, and so on. These synthetic glucocorticoids are generated by modifying some structures based on the cortisone backbone, leading to extension of their biological half-life with stronger activities. In the face of severe infection, allergy, shock, trauma, pain, and other stresses, the demand for glucocorticoids increases dramatically. It is critical to supplement extra glucocorticoids to protect the biological functions of vital organs. However, the amount and duration of glucocorticoid administration need to be carefully adjusted, because a series of side effects may occur after long-term or high-dose usage of glucocorticoids. This review article will discuss the application of glucocorticoids in the treatment of patients with severe or critical COVID-19 and solid tumors of advanced stage. The controversy of using glucocorticoid in medical community will also be discussed. This review article will help doctors and basic researchers better understand the practical application of glucocorticoids.

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Section: Glucocorticoids and Covid-19 Therapymentioning

confidence: 99%

Glucocorticoids are double-edged sword in the treatment of COVID-19 and cancers

Yang¹,

Yu²

2021

Int. J. Biol. Sci.

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“… The early-stage use of a combination of favipiravir and methylprednisolone in severe cases can achieve a favorable clinical outcome 25 Alejandro Rodríguez-Molinero/Spain Cohort study 418 Steroids/No steroids 65.4 56.9% COVID- 19 patients with pulmonary involvement 6 (8.1%)/10(13.2%) Methylprednisolone 1 mg/kg/day or dexamethasone 20–40 mg/day The mortality can not been analysed due to the low number of events. There is no benefit in the use of glucocorticoids in terms of lung function or time to discharge 26 Yan Hu/China Single-center study 308 Steroids/No steroids 54 (44–63)/48 (39–60) 47.2%/46.7% COVID- 19 patients with pulmonary involvement None Equivalent of methylprednisolone 0.75–1.5 mg/kg/d) Glucocorticoid therapy did not significantly influence the clinical course, adverse events nor the outcome of COVID-19 pneumonia 27 Muhammad A. Rana/PAK Retrospective quasi-experimental study 60 Dexamethasone/Methylprednisolone 53.8/53.9 66.7%/70% Patients treated in HDU/ICU and had been on bi-level positive airway pressure. Not mentioned Dexamethasone 8 mg BID/Methylprednisolone 40 mg BID; 8 days Dexamethasone is more effective in improving the P/F ratio in COVID-19 patients compared to methylprednisolone 28 Marla J Keller/UAS Observational study 1806 Steroids/No steroids 61.7 ± 15.9/62.3 ± 17.9 49.3%/46.3% COVID-19 patients Glucocorticoid increased mortality of patients with CRP< 10 mg/dL Early glucocorticoids (within 48 hours of admission) Choosing the right patients is critical to maximize the likelihood of benefit and minimize the risk of harm 29 Hong-Ming Z...…”

Section: Pros and Cons Of Glucocorticoid Therapymentioning

confidence: 99%

Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19—Experience and Lessons from the SARS Epidemic

Zhang¹,

Wang²,

Shi³

et al. 2021

DDDT

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“…In the light of these properties, systemic CSs have been empirically used to manage the cytokine storm in COVID-19 patients and mitigate its most severe manifestations such as ARDS, systemic organ failure and death [ 103 , 104 ]. In the early days of this pandemic, guidance regarding CSs was mixed: on the one hand, data collected during previous coronavirus outbreaks that share many clinical characteristics with COVID-19, SARS and MERS, were inconclusive about efficacy and safety of CSs [ 66 , 105 , 106 , 107 ]; on the other hand, the initial clinical experience on adjunctive therapy with CSs, which was essentially documented by case reports, observational and small (and often single-center) studies, similarly emphasized the need for large scale randomized trials to properly assess CSs on outcomes according to severity of COVID-19 disease [ 51 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 ]. On 6 June 2020, breaking news from the RECOVERY ( R andomized E valuation of COV ID-19 th ER ap Y ) trial based in the United Kingdom (NCT04381936) announced that participants who received 6 mg dexamethasone daily for 10 days saw improvements, and in particular the subsets of patients already on ventilators or who required non-invasive oxygen therapy [ 117 ].…”

Section: Css Use During Covid-19 Pandemic: Pros and Consmentioning

confidence: 99%

Challenges and Opportunities from Targeting Inflammatory Responses to SARS-CoV-2 Infection: A Narrative Review

Lariccia

Magi

Serfilippi

et al. 2020

JCM

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The novel coronavirus disease 2019 (COVID-19) is a global pandemic that continues to sweep across the world, posing an urgent need for effective therapies and prevention of the spread of the severe acute respiratory syndrome related to coronavirus-2 (SARS-CoV-2). A major hypothesis that is currently guiding research and clinical care posits that an excessive and uncontrolled surge of pro-inflammatory cytokines (the so-called “cytokine storm”) drives morbidity and mortality in the most severe cases. In the overall efforts made to develop effective and safe therapies (including vaccines) for COVID-19, clinicians are thus repurposing ready-to-use drugs with direct or indirect anti-inflammatory and immunomodulatory activities. Speculatively, there are many opportunities and challenges in targeting immune/inflammatory processes in the evolving settings of COVID-19 disease because of the need to safely balance the fight against virus and aggressive inflammation versus the suppression of host immune defenses and the risk of additional harms in already compromised patients. To this end, many studies are globally underway to weigh the pros and cons of tailoring drugs used for inflammatory-driven conditions to COVID-19 patient care, and the next step will be to summarize the growing clinical trial experience into clean clinical practice. Based on the current evidence, anti-inflammatory drugs should be considered as complementary approaches to anti-viral drugs that need to be timely introduced in the management of COVID-19 according to disease severity. While drugs that target SARS-CoV-2 entry or replication are expected to confer the greatest benefits at the early stage of the infection, anti-inflammatory drugs would be more effective in limiting the inflammatory processes that drive the worsening of the disease.

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Clinical efficacy of glucocorticoid on the treatment of patients with COVID-19 pneumonia: A single-center experience

Cited by 23 publications

References 22 publications

Glucocorticoids are double-edged sword in the treatment of COVID-19 and cancers

Glucocorticoids are double-edged sword in the treatment of COVID-19 and cancers

Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19—Experience and Lessons from the SARS Epidemic

Challenges and Opportunities from Targeting Inflammatory Responses to SARS-CoV-2 Infection: A Narrative Review

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