The use of corticosteroid therapy for COVID-19 patients: an evidence-based overview
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Published:
Aug 29, 2022
Keywords:
Corticosteroids, COVID-19, SARS-CoV-2, Therapy
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Abstract
Since the World Health Organization declared COVID-19 as a pandemic, huge efforts to promote better treatment for the patients raised from the scientific community. One of the most effective treatment is the administration of corticosteroid in specific stages of the disease, once that severe COVID-19 pathophysiology evolves an exuberant inflammatory response, resulting in uncontrolled pulmonary inflammation and multisystem damage. However, it is still discussed whether some drugs, such as dexamethasone, are more effective than others, such as hydrocortisone and methylprednisolone. Therefore, we constructed here a comprehensive overview, based on clinical studies with detailed methodological procedures, regarding the role of corticosteroids in COVID-19 treatment. We aimed to address how the current evidence support their use in this scenario.
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1.
Amaral RG, Santana RRR, Barbosa BO, Araújo YB, Lauton-Santos S, Andrade LN. The use of corticosteroid therapy for COVID-19 patients: an evidence-based overview. Health Sci J [Internet]. 2022Aug.29 [cited 2024Apr.30];12(3):4-11. Available from: https://portalrcs.hcitajuba.org.br/index.php/rcsfmit_zero/article/view/1264
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NARRATIVE REVIEW
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3. Del Sole F, Farcomeni A, Loffredo L, Carnevale R, Menichelli D, Vicario T, et al. Features of severe COVID-19: A systematic review and meta-analysis. Eur J Clin Invest. 2020;50(10):e13378. https://doi.org/10.1111/eci.13378
4. Fu Y, Cheng Y, Wu Y. Understanding SARS-CoV-2-mediated inflammatory responses: from mechanisms to potential therapeutic tools. Virol Sin. 2020;35(3):266-71. https://doi.org/10.1007/s12250-020-00207-4
5. Perico L, Benigni A, Casiraghi F, Ng LFP, Renia L, Remuzzi G. Immunity, endothelial injury and complement-induced coagulopathy in COVID-19. Nat Rev Nephrol. 2021;17(1):46-64. https://doi.org/10.1038/s41581-020-00357-4
6. Lee KH, Yoon S, Jeong GH, Kim JY, Han YJ, Hong SH, et al. Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis. J Clin Med. 2020;9(8):2392. https://doi.org/10.3390/jcm9082392
7. Kapugi M, Cunningham K. Corticosteroids. Orthop Nurs. 2019;38(5):336-9. https://doi.org/10.1097/NOR.0000000000000595
8. Lam CW, Chan MH, Wong CK. Severe acute respiratory syndrome: clinical and laboratory manifestations. Clin Biochem Rev. 2004;25(2):121-32. PMCId:PMC1904416.
9. van Paassen J, Vos JS, Hoekstra EM, Neumann KMI, Boot PC, Arbous SM. Corticosteroid use in COVID-19 patients: a systematic review and meta-analysis on clinical outcomes. Crit Care. 2020;24(1):696. https://doi.org/10.1186/s13054-020-03400-9
10. Yang JW, Yang L, Luo RG, Xu JF. Corticosteroid administration for viral pneumonia: COVID-19 and beyond. Clin Microbiol Infect. 2020;26(9):1171-7. https://doi.org/10.1016/j.cmi.2020.06.020
11. Peiris M. Respiratory tract viruses. In: Warrell DA, Cox TM, Firth JD. Oxford Textbook of Medicine. 4th ed. Oxford:Oxford Press, 2003. p. 363-68.
12. Huppert LA, Matthay MA, Ware LB. Pathogenesis of acute respiratory distress syndrome. Semin Respir Crit Care Med. 2019;40(1):31-39. https://doi.org/10.1055/s-0039-1683996
13. Swartz SL, Dluhy RG. Corticosteroids: clinical pharmacology and therapeutic use. Drugs. 1978;16(3):238-55. https://doi.org/10.2165/00003495-197816030-00006
14. Annane D, Sébille V, Bellissant E. Effect of low doses of corticosteroids in septic shock patients with or without early acute respiratory distress syndrome. Crit Care Med. 2006; 34(1):22-30. https://doi.org/10.1097/01.CCM.0000194723.78632.62
15. Samuel S, Nguyen T, Choi HA. Pharmacologic characteristics of corticosteroids. J Neurocrit Care. 2017;10(2):53-59. https://doi.org/10.18700/jnc.170035
16. Mokra D, Mikolka P, Kosutova P, Mokry J. Corticosteroids in acute lung injury: the dilemma continues. Int J Mol Sci. 2019;20(19):4765. https://doi.org/10.3390/ijms20194765
17. Li H, Yang SG, Gu L, Zhang Y, Yan XX, Liang ZA, et al. Effect of low‐to‐moderate‐dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1) pdm09 viral pneumonia. Influenza Other Respir Viruses. 2017;11(4):345-54. https://doi.org/10.1111/irv.12456
18. Meduri GU, Siemieniuk RAC, Ness RA, Seyler SJ. Prolonged low-dose methylprednisolone treatment is highly effective in reducing duration of mechanical ventilation and mortality in patients with ARDS. J Intensive Care. 2018;6:53. https://doi.org/10.1186/s40560-018-0321-9
19. Villar J, Ferrando C, Martínez D, Ambrós A, Muñoz T, Soler JA, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020;8(3):267-76. https://doi.org/10.1016/S2213-2600(19)30417-5
20. Rong CC, Xiao PT, Shou YT, Bi LL, Zhuo YW, Ji QF et al. Treatment of severe acute respiratory syndrome with glucosteroids. Chest J. 2006;129(6):1441-52. https://doi.org/10.1378/chest.129.6.1441
21. Lee N, Leo YS, Cao B, Chan PK, Kyaw WM, Uyeki TM, et al. Neuraminidase inhibitors, superinfection and corticosteroids affect survival of influenza patients. Eur Respir J. 2015;45(6):1642-52. https://doi.org/10.1183/09031936.00169714
22. Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam JS, Lim WS. Effect of corticosteroid therapy on influenza-related mortality: a systematic review and meta-analysis. J Infect Dis. 2015;212(2):183-94. https://doi.org/10.1093/infdis/jiu645
23. Shang L, Zhao J, Hu Y, Du R, Cao B. On the use of corticosteroids for 2019-nCoV pneumonia. Lancet. 2020;395(10225):683-4. https://doi.org/10.1016/S0140-6736(20)30361-5
24. Vichyanond P, Irvin CG, Larsen GL, Szefler SJ, Hill MR. Penetration of corticosteroids into the lung: evidence for a difference between methylprednisolone and prednisolone. J Allergy Clin Immunol. 1989;84(6 Pt 1):867-73. https://doi.org/10.1016/0091-6749(89)90381-3
25. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395(10223):473-5. https://doi.org/10.1016/S0140-6736(20)30317-2
26. Tlayjeh H, Mhish OH, Enani MA, Alruwaili A, Tleyjeh R, Thalib L, et al. Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis. J Infect Public Health. 2020;13(11):1652-63. https://doi.org/10.1016/j.jiph.2020.09.008
27. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43. https://doi.org/10.1001/jamainternmed.2020.0994
28. Wang Y, Jiang W, He Q, Wang C, Wang B, Zhou P, et al. A retrospective cohort study of methylprednisolone therapy in severe patients with COVID-19 pneumonia. Signal Transduct Target Ther. 2020;5(1):57. https://doi.org/10.1038/s41392-020-0158-2
29. Angus DC, Derde L, Al-Beidh F, Annane D, Arabi Y, Beane A, et al. Effect of hydrocortisone on mortality and organ support in patients with severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA. 2020;324(13):1317-29. https://doi.org/10.1001/jama.2020.17022
30. Dequin P, Heming N, Meziani F, Plantefève G, Voiriot G, Badié J, et al. Effect of hydrocortisone on 21-Day Mortality or respiratory support among critically ill patients with COVID-19: A Randomized Clinical Trial. JAMA. 2020;324(13):1298-306. https://doi.org/10.1001/jama.2020.16761
31. Jeronimo CMP, Farias MEL, Val FFA, Sampaio VS, Alexandre MAA, Melo GC, et al. Methylprednisolone as Adjunctive Therapy for Patients Hospitalized With Coronavirus Disease 2019 (COVID-19 Metcovid): A Randomized, Double-blind, Phase IIb, Placebo-controlled Trial. Clin Infect Dis. 2021;72(9):e373-e381. https://doi.org/10.1093/cid/ciaa1177
32. Ranjbar K, Moghadami M, Mirahmadizadeh A, Fallahi MJ, Khaloo V, Shahriarirad R, et al. Methylprednisolone or dexamethasone, which one is superior corticosteroid in the treatment of hospitalized COVID-19 patients: a triple-blinded randomized controlled trial. BMC Infect Dis. 2021;21(1):337. https://doi.org/10.1186/s12879-021-06045-3
33. Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30. https://doi.org/10.1186/1710-1492-9-30
34. Ahmed MH, Hassan A. Dexamethasone for the treatment of coronavirus disease (COVID-19): a Review. SN Compr Clin Med. 2020;2(12):2637-46. https://doi.org/10.1007/s42399-020-00610-8
35. RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384(8):693-704. https://doi.org/10.1056/NEJMoa2021436
36. Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA. 2020;324(13):1307-16. https://doi.org/10.1001/jama.2020.17021
37. COVID STEROID 2 Trial Group, Munch MW, Myatra SN, Vijayaraghavan BKT, Saseedharan S, Benfield T, Wahlin RR, et al. Effect of 12 mg vs 6 mg of dexamethasone on the number of days alive without life support in adults with COVID-19 and severe hypoxemia: The COVID STEROID 2 Randomized Trial. JAMA. 2021;326(18):1807-17. https://doi.org/10.1001/jama.2021.18295
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