Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

Cui, Yuqing; Sun, Yali; Sun, Junyi; Liang, Huoyan; Ding, Xianfei; Wang, Dong; Sun, Tongwen

doi:10.1007/s40121-021-00518-3

Cited by 16 publications

(11 citation statements)

References 78 publications

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“…From our cohort, patients using corticoids at the time of recruitment were twice as likely to experience a severe COVID-19 infection. Although the use of corticosteroids was not helpful against the SARS and MERS-CoV diseases (Varghese et al, 2020 ; Cui et al, 2021 ), corticosteroids still are recommended as a treatment for only moderate, severe, and critical SARS-CoV-2 infection (National Institutes of Health, 2020b ; Cui et al, 2021 ; Patel et al, 2021 ; Ro et al, 2021 ). The dose used and duration of treatment with corticosteroids remains contentious.…”

Section: Discussionmentioning

confidence: 99%

Metabolomic Profiling of Plasma Reveals Differential Disease Severity Markers in COVID-19 Patients

et al. 2022

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The severity, disabilities, and lethality caused by the coronavirus 2019 (COVID-19) disease have dumbfounded the entire world on an unprecedented scale. The multifactorial aspect of the infection has generated interest in understanding the clinical history of COVID-19, particularly the classification of severity and early prediction on prognosis. Metabolomics is a powerful tool for identifying metabolite signatures when profiling parasitic, metabolic, and microbial diseases. This study undertook a metabolomic approach to identify potential metabolic signatures to discriminate severe COVID-19 from non-severe COVID-19. The secondary aim was to determine whether the clinical and laboratory data from the severe and non-severe COVID-19 patients were compatible with the metabolomic findings. Metabolomic analysis of samples revealed that 43 metabolites from 9 classes indicated COVID-19 severity: 29 metabolites for non-severe and 14 metabolites for severe disease. The metabolites from porphyrin and purine pathways were significantly elevated in the severe disease group, suggesting that they could be potential prognostic biomarkers. Elevated levels of the cholesteryl ester CE (18:3) in non-severe patients matched the significantly different blood cholesterol components (total cholesterol and HDL, both p < 0.001) that were detected. Pathway analysis identified 8 metabolomic pathways associated with the 43 discriminating metabolites. Metabolomic pathway analysis revealed that COVID-19 affected glycerophospholipid and porphyrin metabolism but significantly affected the glycerophospholipid and linoleic acid metabolism pathways (p = 0.025 and p = 0.035, respectively). Our results indicate that these metabolomics-based markers could have prognostic and diagnostic potential when managing and understanding the evolution of COVID-19.

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Section: Discussionmentioning

confidence: 99%

Metabolomic Profiling of Plasma Reveals Differential Disease Severity Markers in COVID-19 Patients

et al. 2022

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“…Therefore, it was hypothesized that steroids may be an effective treatment for COVID-19 patients given their well-known anti-inflammatory and immunosuppressor effects. Several trials have been conducted to confirm this hypothesis [17,18,20,22]. The RECOVERY study is an openlabel trial that includes a high number of patients treated with dexamethasone 6 mg once daily (n = 2104) or with standard care (n = 4321), showing that the steroid administration may reduce the 28-day mortality, especially in patients receiving oxygen support (with both non-invasive and invasive ventilation) [17].…”

Section: Discussionmentioning

confidence: 99%

Comparison between Dexamethasone and Methylprednisolone Therapy in Patients with COVID-19 Pneumonia Admitted to Non-Intensive Medical Units

Buso

Cinetto

Dell'Edera

et al. 2021

JCM

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(1) Background: Data on different steroid compounds for the treatment of hospitalized COVID-19 (coronavirus disease 2019) patients are still limited. The aim of this study was to compare COVID-19 patients admitted to non-intensive units and treated with methylprednisolone or dexamethasone. (2) Methods: This was a single-center retrospective study that included consecutive patients with COVID-19 hospitalized in medical wards during the second wave of the pandemic. Thirty-day mortality and the need for intensive or semi-intensive care were the main clinical outcomes analyzed in patients receiving methylprednisolone (60 mg/day) compared with dexamethasone (6 mg/day). Secondary outcomes included complication rates, length of hospital stay, and time to viral clearance. (3) Results: Two-hundred-forty-six patients were included in the analysis, 110 treated with dexamethasone and 136 with methylprednisolone. No statistically significant differences were found between the two groups of patients regarding 30-day mortality (OR 1.35, CI95% 0.71–2.56, p = 0.351) and the need for intensive or semi-intensive care (OR 1.94, CI95% 0.81–4.66, p = 0.136). The complication rates, length of hospital stay, and time to viral clearance did not significantly differ between the two groups. (4) Conclusions: In patients hospitalized for COVID-19 in non-intensive units, the choice of different steroid compounds, such as dexamethasone or methylprednisolone, did not affect the main clinical outcomes.

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“…Dexamethasone is preferred over other corticosteroids for its shown efficacy in HLH but there are several other trials reporting positive results with the use of other agents like methylprednisolone in equivalent total daily doses of dexamethasone 6 mg/day (methylprednisolone 32 mg daily or prednisone 40 mg 1 https://www.idsociety.org/covid-19-real-time-learning-network/therapeutics-and-interventions/corticosteroids/ daily) [42][43][44]. Methylprednisolone 250 to 500 mg daily pulses for 3-6 consecutive days has also been shown to improve survival in severe COVID-19 patients [45,46]. Hydrocortisone would be one of the options although its efficacy seemed to be lower than dexamethasone [46].…”

Section: Corticosteroidsmentioning

confidence: 99%

“…Methylprednisolone 250 to 500 mg daily pulses for 3-6 consecutive days has also been shown to improve survival in severe COVID-19 patients [45,46]. Hydrocortisone would be one of the options although its efficacy seemed to be lower than dexamethasone [46]. The open-label STOIC trial showed that, an inhaled steroid, budesonide 400 μg twice a day until symptom resolution, decreased the need for urgent medical care in mild patients with early COVID-19 [47].…”

Section: Corticosteroidsmentioning

confidence: 99%

Immune dysfunction in COVID-19 and judicious use of antirheumatic drugs for the treatment of hyperinflammation

Tufan¹,

Matucci‐Cerinic²

2021

Turk J Med Sci

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In the Wuhan province of China, almost two years ago, in December 2019, the novel Coronavirus 2019 has caused a severe involvement of the lower respiratory tract leading to an acute life-threatening respiratory syndrome, coronavirus disease-19 (COVID-19). Subsequently, coronavirus 2 (SARS-CoV-2) rapidly spread to the entire world causing a pandemic and affected every single person on earth either directly or indirectly with destroying all facets of social life and economy. Since the announcement of COVID-19 as a global pandemic, we have witnessed tremendous scientific work on all aspects of COVID-19 across the globe, which has never been witnessed before. The most remarkable achievement would be the introduction of vaccines, which provide protection from the severe infection and is the only premise for the control of disease. However, despite the tremendous work, the number of treatments either antiviral or immunomodulatory for infected patients are considerably limited, yet disease is causing substantial morbidity and mortality. COVID-19 follows heterogenous disease course among infected individuals, and dysregulated immune system is primarily responsible for the worse outcomes. Immune deficiency, being on corticosteroids for inflammatory diseases, delayed interferon response and advanced age adversely influence prognosis with impairing viral clearance. On the other hand, exuberant immune response with features of cytokine storm is the leading cause of death, which can be alleviated by use of either general immunosuppression with corticosteroids or selective neutralization of potent pro-inflammatory cytokines such as interleukin (IL)-1 and IL-6. Herein, we summarized the potential effective immunomodulatory treatments emphasizing in which patient population it is the most suitable, which dose should be administered, and which is the most appropriate timepoint to administer the drug during the course of the disease.

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Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

Cited by 16 publications

References 78 publications

Metabolomic Profiling of Plasma Reveals Differential Disease Severity Markers in COVID-19 Patients

Metabolomic Profiling of Plasma Reveals Differential Disease Severity Markers in COVID-19 Patients

Comparison between Dexamethasone and Methylprednisolone Therapy in Patients with COVID-19 Pneumonia Admitted to Non-Intensive Medical Units

Immune dysfunction in COVID-19 and judicious use of antirheumatic drugs for the treatment of hyperinflammation

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