Corticosteroids in COVID-19: pros and cons

Abstract

The wide and rapid spread of the COVID-19 pandemic has placed an unanticipated burden on the global healthcare sector. This necessitated a swift response from the international community to reach a solution. Efforts were made in parallel to develop preventative and therapeutic modalities. Since then, drug repurposing has blossomed as a potentially rapid resolution and has included various agents with anti-viral and anti-inflammatory properties. Corticosteroids, being potent anti-inflammatory agents, have been placed under extensive investigation. Various trials have recorded the beneficial outcome of corticosteroids in decreasing the mortality and morbidity of COVID-19. With the high pace of escalating events, the quality and study design of clinical trials are varied. Therefore, this study aims to explore the role of corticosteroids in COVID-19 disease. It inspects the molecular, pharmacologic, and clinical proof behind this theory.

Symptoms and Severity of COVID-19 in Patients with Immune-Mediated Inflammatory Diseases: Experience of a University Medical Center

“…Therapeutic steroid use in COVID-19 is a huge and extensively studied issue of the pandemic. Downregulation of a pathogenic cytokine storm was discussed as beneficial in certain subgroups during acute COVID-19 [ 59 ]. Nevertheless, chronic steroid use—which means pre -existing to SARS-CoV-2 infection—was associated with symptomatic disease and risk for a severe course of COVID-19.…”

Clinical and electrocardiographic correlates of myocardial dysfunction after COVID‐19 in nonhospitalised patients in long‐term follow‐up. Data from the polish long‐covid cardiovascular study

“…Furthermore, some medications can affect heart muscle function, e.g., corticosteroids affecting muscle metabolism and inflammation. Several studies have found a negative impact of long‐term high‐dose corticosteroid therapy during COVID‐19 on the occurrence of, among others, myocardial infarction, bacterial sepsis, cerebrovascular and ophthalmological diseases 44–47 . Similarly, Remdesivir potentially affects cardiac repolarisation 48 .…”

“…Several studies have found a negative impact of long-term high-dose corticosteroid therapy during COVID-19 on the occurrence of, among others, myocardial infarction, bacterial sepsis, cerebrovascular and ophthalmological diseases. [44][45][46][47] Similarly, Remdesivir potentially affects cardiac repolarisation. 48 Several studies have reported cardiovascular side effects of Remdesivir, including bradycardia, hypotension, QTc prolongation, nonspecific T wave changes, and cardiac arrest.…”

“…The authors did not consider the effect of drugs intake chronically or during and after infection, which may affect the occurrence and persistence of disorders in long-COVID. The examined patients were not hospitalized and did not take steroids or Remdesivir; this is particularly important due to the influence of corticosteroids [44][45][46][47] or Remdesivir 48 on heart muscle function. Another limitation is the lack of knowledge about whether patients had myocardial dysfunction before contracting COVID-19, as it had not been previously diagnosed.…”

Avascular Necrosis of the Hip Joint and Femoral Head Related with Long COVID-19 or Post-COVID-19: Case Report Study

“…Steroids can be used in patients with COVID-19, who show progressive deterioration of oxygen saturation, increased activation of the pro-inflammatory response, and rapid worsening of features on chest imagining [30], [31]. Various trials have recorded the beneficial outcome of corticosteroids in decreasing the mortality and morbidity of COVID-19 [32]. In the context of a severe COVID-19 case, where the infection has not been cleared by the initial immune response and has entered the pulmonary phase, the proposed benefit of the introduction of corticosteroids is thought to be due to the downregulation of immune-mediated lung injury and cytokine storm [18].…”