A critical evaluation of glucocorticoids in the management of severe COVID-19

Solinas, Cinzia; Perra, Laura; Aiello, Marco Maria; Migliori, Edoardo; Petrosillo, Nicola

doi:10.1016/j.cytogfr.2020.06.012

Cited by 85 publications

(69 citation statements)

References 25 publications

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“…In further investigations, glucocorticoids have been given in combination with other medical compounds, like anti-malarial drugs, serine protease inhibitors, anti-viral and IL blockers, to estimate if those medications, together, have a synergistic effect [ 49 ]. Recently, a clinical trial carried out in France compared the use of hydroxychloroquine alone, with the use of hydroxychloroquine (600 mg/day for 10 days) in combination with dexamethasone (20 mg/day for 5 days and 10 mg/day for the next subsequent 5 days) in the treatment of patients with ARDS caused by SARS-CoV-2 (phase III).…”

Section: Resultsmentioning

confidence: 99%

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

Ahmed

Hassan

2020

SN Compr. Clin. Med.

184

157

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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.

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Section: Resultsmentioning

confidence: 99%

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

Ahmed

Hassan

2020

SN Compr. Clin. Med.

184

157

View full text Add to dashboard Cite

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“…Hydroxychloroquine has been in widespread use for the treatment of COVID-19 in India (34), Turkey (35), and North America (36), but prolongation of QTc interval has been reported in hydroxychloroquine-treated COVID-19 patients, even those with only mild to moderate disease (37). Remdesivir, glucocorticoids, tocilizumab, and convalescent plasma have also been used as therapeutic options in severe pediatric patients, but these therapies should be used with caution because of their side effects and lack of evidence for their efficacy (38)(39)(40)(41)(42)(43). Furthermore, it is noteworthy that patient selection is critical when using these novel therapies to avoid harm (40,42).…”

Section: Discussionmentioning

confidence: 99%

Epidemiological and Clinical Characteristics of COVID-19 in Children: A Systematic Review and Meta-Analysis

et al. 2020

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Given the relatively low rate and limited publicly available data regarding children with SARS-CoV-2 infection, this knowledge gap should be addressed with urgency. This systematic review with meta-analysis aimed to evaluate the epidemiological spectrum and clinical characteristics of children infected with SARS-CoV-2. Relevant international and Chinese public databases were systematically searched to identify all case studies from January 1, 2020 to May 7, 2020. This study consisted of 96 studies involving 7004 cases. The mean age of pediatric cases was 6.48 years (95% CI 52.0-77.5), 90% had household contact, and 66% presented with mild to moderate clinical syndromes. The main symptoms were fever (47%, 95% CI 41-53%) and cough (42%, 95% CI 36-48%). About 23% of children were asymptomatic, 27% had comorbidity, and 29% had a co-infection. The pooled mean incubation period was 9.57 days (95% CI 7.70-11.44). The shedding of SARS-CoV-2 in the upper respiratory tract lasted 11.43 days, and 75% of patients had virus particles in their stool. A total of 34% of the children had neutropenia and 26% had lymphocytosis. Interferon-alpha (81%) was the most commonly used antiviral drug in the children. The discharge and death rates were 79 and 1%. In conclusion, the transmissibility of pediatric COVID-19 should be not ignored because of the relatively long incubation period, shedding duration, and mild clinical syndromes.

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“…This "cytokine storm" results from an inflammatory over-reaction as a response to SARS-CoV-2 infection that ultimately leads to endothelial cell dysfunction, damage of the vascular barrier, capillary leak and diffuse alveolar damage [35]. In this context, anti-IL-6 inhibitors, such as the monoclonal antibody tocilizumab, inhibitors of JAK kinases, such as baricitinib, and corticosteroids, especially dexamethasone, have been evaluated in patients with severe COVID-19 and have shown promising preliminary results [36][37][38][39].…”

Section: Pulmonary Involvementmentioning

confidence: 99%

Organ-specific manifestations of COVID-19 infection

et al. 2020

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Although COVID-19 presents primarily as a lower respiratory tract infection transmitted via air droplets, increasing data suggest multiorgan involvement in patients that are infected. This systemic involvement is postulated to be mainly related to the SARS-CoV-2 virus binding on angiotensin-converting enzyme 2 (ACE2) receptors located on several different human cells. Lung involvement is the most common serious manifestation of the disease, ranging from asymptomatic disease or mild pneumonia, to severe disease associated with hypoxia, critical disease associated with shock, respiratory failure and multiorgan failure or death. Among patients with COVID-19, underlying cardiovascular comorbidities including hypertension, diabetes and especially cardiovascular disease, has been associated with adverse outcomes, whereas the emergence of cardiovascular complications, including myocardial injury, heart failure and arrhythmias, has been associated with poor survival. Gastrointestinal symptoms are also frequently encountered and may persist for several days. Haematological complications are frequent as well and have been associated with poor prognosis. Furthermore, recent studies have reported that over a third of infected patients develop a broad spectrum of neurological symptoms affecting the central nervous system, peripheral nervous system and skeletal muscles, including anosmia and ageusia. The skin, the kidneys, the liver, the endocrine organs and the eyes are also affected by the systemic COVID-19 disease. Herein, we provide a comprehensive overview of the organ-specific systemic manifestations of COVID-19.

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A critical evaluation of glucocorticoids in the management of severe COVID-19

Cited by 85 publications

References 25 publications

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

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

Epidemiological and Clinical Characteristics of COVID-19 in Children: A Systematic Review and Meta-Analysis

Organ-specific manifestations of COVID-19 infection

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