COVID-19 and corticosteroids: a narrative review

Abstract

It has been reported that corticosteroid therapy was effective in the management of severe acute respiratory syndrome (SARS) and the Middle East Respiratory Syndrome (MERS), and recently in coronavirus disease 2019 (COVID-19). Corticosteroids are potent anti-inflammatory drugs that mitigate the risk of acute respiratory distress syndrome (ARDS) in COVID-19 and other viral pneumonia, despite a reduction of viral clearance; corticosteroids inhibit the development of cytokine storm and multi-organ damage. The risk-benefit ratio should be assessed for critical COVID-19 patients. In conclusion, corticosteroid therapy is an effective way in the management of COVID-19, it reduces the risk of complications primarily acute lung injury and the development of ARDS. Besides, corticosteroid therapy mainly dexamethasone and methylprednisolone are effective in reducing the severity of COVID-19 and associated comorbidities such as chronic obstructive pulmonary diseases (COPD), rheumatoid arthritis, and inflammatory bowel disease (IBD).

Keywords: COVID-19; Comorbidities; Corticosteroids.

Fig. 1

Chemical structures of main corticosteroids: A: cortisol, B: aldosterone

Fig. 2

Mechanism of corticosteroids action: corticosteroid (CS) activates corticosteroid receptor (CR) with activation expression of DNA; this effect activates anti-inflammatory mediators and inhibits inflammatory mediators (Sibila et al. 2015)

Fig. 3

The possible effects of corticosteroids in COVID-19. IL-8 (interleukin 8), MCP-1 (monocyte chemoattractant protein 1), IP-10 (interferon-γ-inducible protein 10), IL-6 (interleukin 6), IFN-γ (interferon-gamma, TNF-α (tumor necrosis factor-alpha) and IL-4 (interleukin 4)