Corticosteroids for COVID-19-Associated ARDS

Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study

“…4 Department of Biostatistics, University of Rovira i Virgili (URV), Reus, Spain. 5 Tarragona Health Data Research Working Group (THeDaR), Joan XXIII University Hospital, Tarragona, Spain. 6 Critical Care Department, URV/IISPV/ CIBERES, Joan XXIII University Hospital, Tarragona, Spain.…”

“…Worldwide, corticosteroids have become the standard of care (SOC) for severe COVID-19 patients, especially in mechanically ventilated patients since the results of the RECOVERY trial [3] and the subsequent meta-analysis [4] from seven randomized clinical trials (RCTs) revealed a reduction in 28-day mortality. However, several questions remain unanswered regarding the effectiveness of corticosteroids [5,6]. It is unclear if there are particular subsets of COVID-19 patients under mechanical ventilation with different severity of illness or ARDS degree in whom corticosteroids perhaps had less pronounced effect and caution in the use of corticosteroids should be exercised.…”

Comparison of the efficacy of equivalent doses of dexamethasone, methylprednisolone, and hydrocortisone for treatment of COVID-19-related acute respiratory distress syndrome: a prospective three-arm randomized clinical trial

“…Hence, it is hypothesized that besides respiratory-support modalities, medical therapies that effectively reduce lung inflammation may be lifesaving in patients with COVID-19-related ARDS [ 8 ]. Among many anti-inflammatory agents that have been used to reduce inflammatory responses and mitigate lung damage in severe COVID-19 infection, corticosteroids, due to their accessibility and affordability, have attracted considerable attention around the world [ 9 ]. Although previous studies evaluating corticosteroid treatment in cases with viral infection-related ARDS have failed to show consistent benefit [ 10 , 11 ], emerging evidence strongly supports the potentially beneficial effects of corticosteroids in improving the survival of patients with COVID-19-associated ARDS [ 9 , 12 ].…”

“…Among many anti-inflammatory agents that have been used to reduce inflammatory responses and mitigate lung damage in severe COVID-19 infection, corticosteroids, due to their accessibility and affordability, have attracted considerable attention around the world [ 9 ]. Although previous studies evaluating corticosteroid treatment in cases with viral infection-related ARDS have failed to show consistent benefit [ 10 , 11 ], emerging evidence strongly supports the potentially beneficial effects of corticosteroids in improving the survival of patients with COVID-19-associated ARDS [ 9 , 12 ]. The RECOVERY trial was the first trial that provided data on the mortality benefit of dexamethasone therapy in patients with COVID-19 needing oxygen therapy or mechanical ventilation [ 13 ].…”

“…Although corticosteroids are extensively used in the treatment of patients with severe COVID-19 on respiratory support at present, numerous aspects of their use, such as the preferred agent, optimal dose, and treatment duration, are not yet determined [ 9 ]. Regarding corticosteroid agents, dexamethasone at a dose of 6 mg once daily for up to 10 days is recommended as the first choice by most guidelines on COVID-19 treatment, and other corticosteroids such as hydrocortisone and methylprednisolone at equivalent doses are considered an alternative when dexamethasone is not available [ 15 ].…”