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Review
. 2021 Aug:81:100818.
doi: 10.1016/j.jbior.2021.100818. Epub 2021 Jul 15.

Nonsteroidal anti-inflammatory drugs and glucocorticoids in COVID-19

Emanuela Ricciotti  1 , Krzysztof Laudanski  2 , Garret A FitzGerald  3
Affiliations
Review

Nonsteroidal anti-inflammatory drugs and glucocorticoids in COVID-19

Emanuela Ricciotti et al. Adv Biol Regul. 2021 Aug.

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by a wide spectrum of symptom severity, which is manifested at different phases of infection and demands different levels of care. Viral load, host innate-immune response to SARS-CoV-2, and comorbidities have a direct impact on the clinical outcomes of COVID-19 patients and determine the diverse disease trajectories. The initial SARS-CoV-2 penetrance and replication in the host causes death of infected cells, determining the viral response. SARS-CoV-2 replication in the host triggers the activation of host antiviral immune mechanisms, determining the inflammatory response. While a healthy immune response is essential to eliminate infected cells and prevent spread of the virus, a dysfunctional immune response can result in a cytokine storm and hyperinflammation, contributing to disease progression. Current therapies for COVID-19 target the virus and/or the host immune system and may be complicated in their efficacy by comorbidities. Here we review the evidence for use of two classes of anti-inflammatory drugs, glucocorticoids and nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of COVID-19. We consider the clinical evidence regarding the timing and efficacy of their use, their potential limitations, current recommendations and the prospect of future studies by these and related therapies.

Keywords: COVID-19; Glucocorticoid; Immune-response; Inflammation; NSAID; Prostanoids.

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