Corticosteroids for COVID-19

Abstract

COVID-19 is placing a major burden on healthcare, economy and social systems worldwide owing to its fast spread and unacceptably high death toll. The unprecedented research effort has established the role of a deregulated immune response to the severe acute respiratory syndrome coronavirus 2 resulting in systemic inflammation. Thereafter, the immunomodulatory approach has been place in the top list of the research agenda for COVID-19. Corticosteroids have been used for more than 70 years for modulating immune response in a broad variety of disease. These drugs have been shown to prevent and attenuate the inflammation both in tissues and in the circulation via non-genomic and genomic effects. At the bedside, numerous observational cohorts have been published the past months and have been inconclusive. Randomized controlled trials with subsequent high quality meta-analyses have provided moderate to strong certainty for increased chance of survival and relief from life supportive therapy with corticosteroids given at a dose of 6mg per day of dexamethasone or equivalent doses of hydrocortisone or methylprednisolone. The corticotherapy was not associated with increased risk of bacterial infection or of delayed viral clearance. In daily practice, physicians may be encouraged to use to corticosteroids when managing patients with COVID-19 requiring oxygen supplementation.

Drug Interactions for Patients with Respiratory Diseases Receiving COVID-19 Emerged Treatments

“…They also seem to induce transporter proteins, such as OATP2 and P-gp. The clinical significance of the resulted DDIs is dependent on the administered dosage and period of treatment [ 83 , 84 , 85 , 86 ].…”

Hyaluronic Acid—Dexamethasone Nanoparticles for Local Adjunct Therapy of Lung Inflammation

“…Death rates drop by 1/3 among patients on ventilators and by 1/5 among patients receiving oxygen with no artificial ventilation [ 8 ]. Moreover, DEX treatment can shorten the hospitalization period ([ 9 ] and references therein). In fact, the overreaction of the immune system often occurring in patients with serious cases of COVID-19 can be suppressed by DEX, which is a strong and effective anti-inflammatory corticoid, and inflammation can be restrained.…”

Calming the Storm: A review of corticosteroid use in severely ill COVID-19 patients on mechanical ventilation

“…This process occurs in both tissue and systemic circulation via non-genomic and genomic effects. 3 Corticosteroids may be administered intravenously (IV) or orally in severely ill patients. 2,3 Most literature recommends the use of dexamethasone 6 mg daily for up to 10 days or an equivalent dose of hydrocortisone 50 mg every 8 hours, prednisone 40 mg daily, or methylprednisolone 32 mg daily (8 mg every 6 hours or 16 mg every 12 hours).…”

“…3 Corticosteroids may be administered intravenously (IV) or orally in severely ill patients. 2,3 Most literature recommends the use of dexamethasone 6 mg daily for up to 10 days or an equivalent dose of hydrocortisone 50 mg every 8 hours, prednisone 40 mg daily, or methylprednisolone 32 mg daily (8 mg every 6 hours or 16 mg every 12 hours). 1,2 Corticosteroids have been studied extensively in ARDS patients 3 and are recommended in patients with persistent or refractory moderate to severe disease, who have refractory sepsis or community-acquired pneumonia.…”