Corticosteroids for COVID-19

Abstract

Coronavirus disease 19 (COVID-19) is placing a major burden on healthcare, economy and social systems worldwide owing to its fast spread and unacceptably high death toll. The unprecedented research effort has established the role of a deregulated immune response to the severe acute respiratory syndrome coronavirus 2, resulting in systemic inflammation. After that, the immunomodulatory approach has been placed in the top list of the research agenda for COVID-19. Corticosteroids have been used for more than 70 years to modulate the immune response in a broad variety of diseases. These drugs have been shown to prevent and attenuate inflammation both in tissues and in circulation via non-genomic and genomic effects. At the bedside, numerous observational cohorts have been published in the past months and have been inconclusive. Randomized controlled trials with subsequent high quality meta-analyses have provided moderate to strong certainty for an increased chance of survival and relief from life supportive therapy with corticosteroids given at a dose of 6 mg per day dexamethasone or equivalent doses of hydrocortisone or methylprednisolone. The corticotherapy was not associated with an increased risk of bacterial infection or of delayed viral clearance. In daily practice, physicians may be encouraged to use corticosteroids when managing patients with COVID-19 requiring oxygen supplementation.

Keywords: Coronavirus; Corticosteroids; Inflammatory mediators; Superinfections; Survival; Trials.

Fig. 1

Corticosteroids associated mortality in observational cohorts. Forest plot showing risk ratio for mortality in the short term for corticotherapy versus usual care in observational cohorts.

Fig. 2

Corticosteroids effects on mortality in randomized controlled trials. Forest plot showing risk ratio for mortality in the short term for corticotherapy versus usual care or placebo in randomized controlled trials.

Fig. 3

Serious infections associated with corticosteroids in randomized controlled trials. Forest plot showing risk ratio for serious infectious complications with corticotherapy versus usual care or placebo in randomized controlled trials.