Corticosteroids in COVID-19: one size does not fit all

Gogali, Athena; Kyriakopoulos, Christos; Κostikas, Κonstantinos

doi:10.1183/13993003.00224-2021

Cited by 14 publications

(15 citation statements)

References 6 publications

(4 reference statements)

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“…It just emphasises that the decision to use corticosteroids needs to be individually tailored, first and foremost according to age, but also with regards to comorbidities and other factors. [7] Our analysis has limitations: First, this is a secondary analysis of a prospective study.…”

Section: Discussionmentioning

confidence: 99%

Steroid use in elderly critically ill COVID-19 patients

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Steroid use in elderly critically ill COVID-19 patients

et al. 2021

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“…Notably, a large proportion of patients received concomitant corticosteroids (up to 60% overall; Table S1 in the Supporting Information) in these studies, and possibly in some instances in higher doses as life-saving treatment. 81 In our secondary analysis, a reduction in mortality was observed irrespective of the use of systemic corticosteroids; however, combination therapy had a more pronounced effect on mortality (RR 0.57 in the corticosteroids group vs. 0.70 in the no-corticosteroids group). The data from observational studies, despite their significant heterogeneity, overall support the observation in RCTs for a beneficial effect of tocilizumab on mortality, which may be more prominent in addition to systemic corticosteroids that anyway represent the cornerstone of treatment of patients with COVID-19 and respiratory failure.…”

Section: Discussionmentioning

confidence: 60%

“…These studies are characterized by significant heterogeneity regarding participants' characteristics, study protocols, drug dosage and route of administration, standard of care regimens and, most importantly, a plausible selection bias in the decision for administration of tocilizumab. Notably, a large proportion of patients received concomitant corticosteroids (up to 60% overall; Table S1 in the Supporting Information) in these studies, and possibly in some instances in higher doses as life‐saving treatment 81 . In our secondary analysis, a reduction in mortality was observed irrespective of the use of systemic corticosteroids; however, combination therapy had a more pronounced effect on mortality (RR 0.57 in the corticosteroids group vs. 0.70 in the no‐corticosteroids group).…”

Section: Discussionmentioning

confidence: 97%

Tocilizumab administration for the treatment of hospitalized patients with COVID‐19: A systematic review and meta‐analysis

et al. 2021

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Tocilizumab has been repurposed against the 'cytokine storm' in the setting of coronavirus disease 2019 . Our aim was to evaluate the efficacy of tocilizumab in the management of hospitalized COVID-19 patients. We searched MEDLINE, CENTRAL and medRxiv for studies of tocilizumab in hospitalized COVID-19 patients. Primary objective was the effectiveness of tocilizumab on mortality. Secondary objectives included the need for invasive mechanical ventilation (IMV), composite endpoints of mortality or IMV and intensive care unit (ICU) admission or IMV, length of hospitalization and differences in mortality in subgroups (ICU and non-ICU patients and patients receiving or not receiving concomitant corticosteroids). We included 52 studies (nine randomized controlled trials [RCTs] and 43 observational) with a total of 27,004 patients. In both RCTs and observational studies, the use of tocilizumab was associated with a reduction in mortality; 11% in RCTs (risk ratio [RR] 0.89, 95% CI 0.82 to 0.96) and 31% in observational studies (RR 0.69, 95% CI 0.58 to 0.83). The need for IMV was reduced by 19% in RCTs (RR 0.81, 95% CI 0.71 to 0.93), while no significant reduction was observed in observational studies. Both RCTs and observational studies showed a benefit from tocilizumab on the composite endpoint of mortality or IMV. Tocilizumab improved mortality both in ICU and non-ICU patients. Reduction in mortality was evident in observational studies regardless of the use of systemic corticosteroids, while that was not the case in the RCTs. Tocilizumab was associated with lower mortality and other clinically relevant outcomes in hospitalized patients with moderate-to-critical COVID-19.

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“…Dexamethasone is usually given to hospitalized COVID-19 patients requiring oxygen therapy. In a recent report, it was shown that in patients hospitalized with COVID-19, the use of Dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at random, but not among those receiving no respiratory support [205][206][207].…”

Section: Corticosteroid Compoundsmentioning

confidence: 99%

A Multidisciplinary Approach to Coronavirus Disease (COVID-19)

Ertürk

Şahin

et al. 2021

Molecules

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Since December 2019, humanity has faced an important global threat. Many studies have been published on the origin, structure, and mechanism of action of the SARS-CoV-2 virus and the treatment of its disease. The priority of scientists all over the world has been to direct their time to research this subject. In this review, we highlight chemical studies and therapeutic approaches to overcome COVID-19 with seven different sections. These sections are the structure and mechanism of action of SARS-CoV-2, immunotherapy and vaccine, computer-aided drug design, repurposing therapeutics for COVID-19, synthesis of new molecular structures against COVID-19, food safety/security and functional food components, and potential natural products against COVID-19. In this work, we aimed to screen all the newly synthesized compounds, repurposing chemicals covering antiviral, anti-inflammatory, antibacterial, antiparasitic, anticancer, antipsychotic, and antihistamine compounds against COVID-19. We also highlight computer-aided approaches to develop an anti-COVID-19 molecule. We explain that some phytochemicals and dietary supplements have been identified as antiviral bioproducts, which have almost been successfully tested against COVID-19. In addition, we present immunotherapy types, targets, immunotherapy and inflammation/mutations of the virus, immune response, and vaccine issues.

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Corticosteroids in COVID-19: one size does not fit all

Cited by 14 publications

References 6 publications

Steroid use in elderly critically ill COVID-19 patients

Steroid use in elderly critically ill COVID-19 patients

Tocilizumab administration for the treatment of hospitalized patients with COVID‐19: A systematic review and meta‐analysis

A Multidisciplinary Approach to Coronavirus Disease (COVID-19)

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