Corticosteroids: A boon or bane for COVID-19 patients?

Abstract

Several drugs and antibodies have been repurposed to treat COVID-19. Since the outcome of the drugs and antibodies clinical studies have been mostly inconclusive or with lesser effects, therefore the need for alternative treatments has become unavoidable. However, corticosteroids, which have a history of therapeutic efficacy against coronaviruses (SARS and MERS), might emerge into one of the pandemic's heroic characters. Corticosteroids serve an immunomodulatory function in the post-viral hyper-inflammatory condition (the cytokine storm, or release syndrome), suppressing the excessive immunological response and preventing multi-organ failure and death. Therefore, corticosteroids have been used to treat COVID-19 patients for more than last two years. According to recent clinical trials and the results of observational studies, corticosteroids can be administered to patients with severe and critical COVID-19 symptoms with a favorable risk-benefit ratio. Corticosteroids like Hydrocortisone, dexamethasone, Prednisolone and Methylprednisolone has been reported to be effective against SARS-CoV-2 virus in comparison to that of non-steroid drugs, by using non-genomic and genomic effects to prevent and reduce inflammation in tissues and the circulation. Clinical trials also show that inhaled budesonide (a synthetic corticosteroid) increases time to recovery and has the potential to reduce hospitalizations or fatalities in persons with COVID-19. There is also a brief overview of the industrial preparation of common glucocorticoids.

Keywords: COVID-19; Corticosteroids; Glucocorticoids; Remdesivir; Repurposed drugs.

Fig. 1

Common Steroids used for COVID-19 treatment: Skeleton for corticosteroids.

Scheme 1

Synthesis of hydrocortisone from diosgenin.

Scheme 2

Synthesis of hydrocortisone from progesterone derivatives.

Scheme 3

Synthesis of dexamethasone from tigogenin.

Scheme 4

Synthesis of dexamethasone from sitosterol.

Scheme 5

Synthesis of prednisolone from triketone derivative.

Scheme 6

Synthesis of prednisolone from prednisone acetate.

Scheme 7

Synthesis of methyl prednisolone from hydrocortisone.

Fig. 2

Genomic (continuous arrows) and non-genomic (dashed arrows) mechanism of corticosteroids. (This image is taken from , an open access paper).

Fig. 3

Skeleton of three new reported steroids.