Potential benefits of precise corticosteroids therapy for severe 2019-nCoV pneumonia

Zhou, Wei; Liu, Yisi; Tian, Dongdong; Wang, Cheng; Wang, Sa; Cheng, Jing; Hu, Ming; Fang, Minghao; Gao, Yue

doi:10.1038/s41392-020-0127-9

Cited by 225 publications

(259 citation statements)

References 11 publications

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“…As shown in Figure 1, among 31 initially included studies (14 in English and 17 in Chinese), eight were reviewed as full-text and four finally included (14)(15)(16)(17). Two studies were excluded since they were commentaries (9, 10), one excluded as it was a protocol (18), and one a letter to Editor (19). Table 1 shows the descriptive characteristics of the four included studies.…”

Section: Search Resultsmentioning

confidence: 99%

Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature

et al. 2020

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Section: Search Resultsmentioning

confidence: 99%

Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature

et al. 2020

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“…Moreover, corticosteroid use was prolonged SARS-CoV-2 RNA shedding as observed in SARS and MERS infections [54]. In the light of preliminary data, corticosteroids are more likely to function on inflammation-mediated lung injury and interstitial fibrosis at late-stage of ARDS [52]. However, the dose, duration, and timing of corticosteroids must be individualized considering risk-benefit ratio, until results of ongoing well-designed prospective cohort studies obtained.…”

Section: Potential Antiinflammatory Treatments Used In Rheumatology Fmentioning

confidence: 99%

COVID-19, immune system response, hyperinflammation and repurposing antirheumatic drugs

2020

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IntroductionCoronaviruses (CoVs), mainly targeting human respiratory system, are responsible for health-threatening outbreaks including severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and lastly coronavirus disease 2019 (COVID-19) [1]. In December 2019, in the Chinese Province of Wuhan the novel coronavirus has been identified in patients with atypical pneumonia characterized by fever, dry cough and progressive dyspnea [2]. Rapidly, this coronavirus, namely SARS-CoV-2 1 , has spread worldwide, leading to a serious lung inflammation, acute respiratory distress syndrome (ARDS), cardiac and renal injury, especially in patients with older age and comorbidities (diabetes mellitus, hypertension, and heart failure) [3][4][5]. According to disease progression, patients may be roughly divided into two groups; asymptomatic or mild cases that usually 2.The origin and structural features of SARS-CoV2CoVs belong to big family Coronaviridae which consists of two subfamilies: Orthocoronavirinae and Torovirinae.

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“…The indication for corticosteroids was reported in 7/22 studies and varied: most frequently it comprised (a combination of) worsening oxygenation, severe radiological ndings, ICU admission, or persistence of in ammatory symptoms. [33,[38][39][40][41][42][43] The median time of initiation after admission was reported in 8/22 studies and varied from 24 hours after hospital admission, [44] immediately after ICU admission [43] to approximately eight to fourteen days after onset of symptoms. [23,41,42,[45][46][47] One study compared early (average 2 days after hospital admission) to late corticosteroid administration (average 5 days after hospital admission).…”

Section: Resultsmentioning

confidence: 99%

“…[33] Methylprednisolone was the most frequently used corticosteroid (13/22 studies). [33,[37][38][39][40][42][43][44]46,[48][49][50][51] In two studies methylprednisolone, hydrocortisone, or dexamethasone was used. [36,41] Ling et al used prednisolone or dexamethasone, [52] and Horby et al reported on dexamethasone use.…”

Section: Resultsmentioning

confidence: 99%

Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

Hoekstra

Neumann

Boot

et al. 2020

Preprint

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Background In the current SARS-CoV-2 pandemic, there has been worldwide debate on the use of corticosteroids in COVID-19. In a recent RCT (RECOVERY trial), a reduced 28-day mortality in patients requiring oxygen therapy or mechanical ventilation evaluating the effect of dexamethasone was shown. Their results have led to considering amendments in guidelines or actually already recommending corticosteroid use in COVID-19. However, the supposed effect of corticosteroids on mortality and viral clearance remains unclear and a clear evidence-based therapeutic strategy is still lacking.Objectives The aim of this systematic review and meta-analysis was to evaluate the effect of corticosteroids on mortality, viral clearance and secondary outcomes in COVID-19 patients.Data source, study eligibility, participants, interventionsA systematic literature search was performed across Medline/PubMed, Embase, and Web of Science from 1st of December 2019 until 10th of July 2020, according to the PRISMA guidelines. RCTs and cohort studies reporting in English, on ≥15 adult COVID-19 patients, treated with any type of corticosteroid therapy were included. Studies on pregnant women, reviews and with a NOS (Newcastle Ottawa Scale for validity assessment of observational studies) score of ≤4 were excluded.Results Twenty-two articles were included, covering 9,760 patients. In eight studies, the effect of corticosteroid use was quantified. The pooled estimate of the observational studies supported the positive effect on mortality of corticosteroid therapy in COVID-19 as reported in the RECOVERY trial, in respiratory compromised COVID-19 patients, i.e. oxygen or mechanical ventilation dependent or with ARDS. The overall pooled estimate (observational studies and the RCT) showed reduced mortality in the corticosteroid group (relative risk 0.55 [95% CI 0.27-0.83]). Furthermore, mechanical ventilation rate seemed lower in corticosteroid treated COVID-19 patients, though no definite conclusions could be drawn because of a low number of studies. With regard to potential side effects of corticosteroids, the effect on viral clearance duration was ambiguous, i.e. prolonged in 4 of 9 and without effect in 5 of 9 studies.Conclusions It appears safe with respect to viral clearance to administer corticosteroids in respiratory compromised COVID-19 patients with possible improvement in mortality and conflicting effects on viral clearance.

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Potential benefits of precise corticosteroids therapy for severe 2019-nCoV pneumonia

Cited by 225 publications

References 11 publications

Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature

Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature

COVID-19, immune system response, hyperinflammation and repurposing antirheumatic drugs

Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

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