Corticosteroids in SARS-COV2 infection: certainties and uncertainties in clinical practice

Abstract

Introduction The SARS-COV-2 pandemic is a worldwide public health problem due to the large medical burden and limited number of therapies available. Corticosteroids have a rather unclear efficacy in viral non-SARS-COV-2 pneumonias and therefore their use is not universally recommended. In SARS-COV-2 pneumonia however, it is expected that they can reduce the deleterious consequences of the virus-related systemic inflammation. Areas covered a MEDLINE search covering the period 1995–2020 was completed to identify relevant papers. SARS-COV-2 pathogenesis is very complex and is represented by the interplay of many cytokine-driven inflammation pathways. Its most severe form so called cytokine storm, is an exaggerate reaction of the host infected by the virus rapidly resulting in multiple organ dysfunction (MODS). Corticosteroids have the potential to blunt the inflammation response in such patients, but their efficacy is not the same for all patients. Further on the certainties and uncertainties regarding the efficacy of this therapy in SARS-COV-2 pneumonia are discussed Expert Opinion In patients with severe SARS-COV-2 pneumonia, corticosteroids can be efficacious, but it is still not clear if they can be safely used in patients with comorbid cardiovascular disease or how the optimal duration of therapy can be established.

Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study

“…Although some studies have suggested that low-dose corticosteroid therapy appeared to have a beneficial role in managing patients with COVID-19, the results have been controversial. 37 , 38 It is now widely believed that low-dose corticosteroids effectively reduced the risk of mortality, respiratory failure, and delayed viral clearance of patients with severe COVID-19. 13 , 39 , 40 In a study evaluating the effects of low dose of corticosteroids, it was found that, in patients with severe COVID-19, the use of corticosteroids was associated with less likelihood of mortality and care escalation and significantly shorter hospitalizations.…”

A prospective study of the impact of glycaemic status on clinical outcomes and anti-SARS-CoV-2 antibody responses among patients with predominantly non-severe COVID-19

“…For patients treated for COVID-19, one or more of the following were given: clofazimine [20] , ribavirin, interferon beta-1b, or remdesivir [21] . Dexamethasone [22] was added at physicians’ discretion as clinically indicated.…”

The Impact of Interferon Beta-1b Therapy on Thyroid Function and Autoimmunity Among COVID-19 Survivors

“…For patients treated for COVID-19, one or more of the following were given: clofazimine (12), ribavirin, interferon beta-1b, or remdesivir (2). Dexamethasone (13) and subcutaneous low-molecular-weight heparin (LMWH) (14) were added at physicians' discretion as clinically indicated. Interferon beta-1b was given once daily subcutaneously at a dose of 16 million IU.…”