Dexamethasone for the Treatment of Coronavirus Disease (COVID-19): a Review

Abstract

The World Health Organization (WHO) declared COVID-19 (novel coronavirus) as a global pandemic in the middle of March 2020, after the disease spread to more than 150 countries and territories leading to tens of thousands of cases within a couple of months. To date, there are no effective pharmaceutical treatments available. As well as that, the novel vaccines have not yet been approved as establishing their efficacy will take time. This study aims to summarize the evidence regarding corticosteroids such as dexamethasone for the treatment of COVID-19. Electronic searches were conducted on 7 September 2020 on Google Scholar database, MEDLINE and PubMed. A further search was conducted on the World Health Organization’s COVID-19 research article database. The findings of recent investigations that proved, both, the in vitro and in vivo activity of corticosteroids against COVID-19 and other coronavirus-related pneumonia were discussed. Low doses of corticosteroids (dexamethasone) could reduce the mortality in patients with severe COVID-19 disease; however, they had no effect on the mortality rate of those patients with a mild form of the condition. Moreover, the liberal use of corticosteroids was not advocated for, as high doses of the drug can cause more harm than good.

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – A narrative review

“…Data from larger randomized controlled studies on pharmacological, antiviral, and/or immune-modulating drugs do not conclusively show efficacy in patients with severe COVID-19/CARDS. However, a number of pharmacological treatment approaches have been proposed with some being tested in active clinical trials, including immunosuppressants and/or other immune-modulating drugs [ [103] , [104] , [105] ].…”

Clinical Management of Hypertension, Inflammation and Thrombosis in Hospitalized COVID-19 Patients: Impact on Survival and Concerns

“…The use of corticosteroids has received many positive reviews, in particular dexamethasone, as treatment for COVID-19 patients, popularly acquiring the qualification as the ultimate cure for the disease, while those scientific reports critically reviewing the results did not get the required dissemination [ 45 , 46 ]. We assessed the impact of corticosteroid administration to COVID-19 patients in the cohort of the study, filtering out those patients treated with NSAIDs or other immunosuppressing drugs (see Table S2 ).…”

“…We should consider that corticosteroids in particular may unbalance the immune response in unexpected ways, which might compromise the fight against the virus [ 33 , 34 , 45 , 46 ]. Paradoxically, the use of steroids can potentially cause an unbalanced immune response (e.g., lower cytokine release, but enhanced cytokine-receptor expression plus neutrophil mobilization increase, among others), which may not favor good evolution in these patients [ 47 , 48 ].…”

Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center

“…However, its use is still controversial and more research is needed. [18][19][20] Other studies have also found that the risk of syndrome severity and mortality is significantly high in patients with DM. In addition, individuals with impaired glucose tolerance or DM have been reported to have a 50-60% increased risk of lung infection.…”