COVID-19 infection and glucocorticoids: update from the Italian Society of Endocrinology Expert Opinion on steroid replacement in adrenal insufficiency

Efficacy and Safety of Corticosteroid Treatment in Patients With COVID-19: A Systematic Review and Meta-Analysis

“…The function of corticosteroids is to suppress the immune response as well as innate immunity. However, the elimination of the virus requires the involvement of innate immunity at the early stage, and the use of corticosteroids may delay the clearance of the virus (Ai et al, 2020;Isidori et al, 2020). Our results showed that corticosteroid therapy did not increase the virus clearance time regardless of the severity of COVID-19.…”

“…These beneficial effects might result from reducing the excessive inflammatory responses of COVID-19. As mentioned above, COVID-19 infection can causes a massive cytokine release (namely, cytokine storm), and leading to severe complications, such as acute respiratory distress syndrome (ARDS), disseminated thromboembolism, and hypotensive shock, and leads to a high risk of mortality (Isidori et al, 2020). These diseases are mostly driven by immunoinflammatory reactions.…”

“…Moreover, the severity of the disease may also affect the outcome of corticosteroids. Some individuals with mild COVID-19 causes a specific adaptive immune response in the early stage (Isidori et al, 2020;Shi et al, 2020). The initial response begins with the recruitment of innate immune factors.…”

Pathological Anatomy of Infection Caused by Sars-Cov-2

“…Опубликованные до сих пор данные не учитывают возможности прямой агрессии этого вируса в отношении надпочечников у ранее здоровых людей [77,78]. В исследованных нами аутопсиях людей, погибших от тяжелых форм инфекции с признаками острой надпочечниковой недостаточности, нередко выявлялись кровоизлияния в надпочечниках (рис.…”

Research Progress of Genetic Structure, Pathogenic Mechanism, Clinical Characteristics, and Potential Treatments of Coronavirus Disease 2019

“…For instance, in a large multinational real-world analysis, Mandeep et al did not observe any benefit of hydroxychloroquine or chloroquine on in-hospital outcomes early after diagnosis of COVID-19 ( Mehra et al, 2020 ). Furthermore, considering that corticosteroids may delay the elimination of the virus and increase the risk of secondary infections, especially for patients with compromised immune systems, the WHO guidance on the clinical management of SARS-CoV-2 doesn’t recommend to use corticosteroids during treatment ( Isidori et al, 2020 ). However, in a controlled, open-label randomized evaluation of therapy trial of dexamethasone in hospitalized patients with SARS-CoV-2, Horby et al found that among patients receiving invasive mechanical ventilation, the mortality rate of the dexamethasone group was lower than that of the usual care group (29.3 vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) ( Horby et al, 2020 ).…”