Treatment with Corticosteroids in Critical, Severe and Non-Severe COVID-19

Attapon Cheepsattayakorn*, Ruangrong Cheepsattayakorn¹

1.Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

*Corresponding Author: Dr. Attapon Cheepsattayakorn, 10th Zonal Tuberculosis and Chest Disease Center, 143 Sridornchai Road Changklan Muang Chiang Mai 50100 Thailand.

Received Date: September 17, 2020

Publication Date: October 01, 2020

Glucocorticoids or corticosteroids have main anti-inflammatory effects to inhibit a vast number of pro-inflammatory genes that involve encoding of cell adhesion molecules, chemokines, cytokines, inflammatory receptors and enzymes  to restore  homeostasis  and address  the  inflammatory process.  A previous systematic review  and meta-analysis  revealed  that severe  COVID-19  patients were  more  likely to  require  corticosteroids  treatment (RR =1.56, 95 %  CI = 1.28-1.90, p < 0.001).  The length  of  stay (LOS) was longer  in  the corticosteroid  group (WMD = 6.31, 95 %  CI = 5.26-7.37, p < 0.001, I2 = 1.8 %, p = 0.361 as  well  as the  same  results in  the  subgroup analysis  of  SARS-CoV-infected  patients (WMD = 6.34, 95 %  CI = 5.24-7.44, p < 0.001, I2 = 50.3 %, p = 0.156).  X et al  demonstrated  that COVID-19  patients  treated with  corticosteroids  were more  likely  to be  associated  with harm, whereas  Russell  et al  concluded  that neither  inhaled  or systemic  corticosteroids  was distinguished.

 The WHO recommends systemic corticosteroids rather  than no systemic  corticosteroids  for the  treatment  of critical  and severe COVID-19 patients (strong recommendation, based on moderate certainty evidence). Even the WHO’s strong recommendations, these recommendations should not be  applied to  patients  in whom  the  intervention is contraindicated  as determined  by  the treating clinician.  These recommendations are applied to critical  and severe  COVID-19  patients regardless of hospitalization status.

The WHO suggests not to use corticosteroids in treating non-severe COVID-19 patients (conditional recommendation based on low certainty evidence). In conclusion, urge caution before using orticosteroids for ARDS-associated COVID-19. Corticosteroids are not recommended for mild  COVID-19  patients. Moderate corticosteroids can  be  used in  critical  and severe  COVID-19  patients. Currently, there  has  been no  enough  clinical trials  or  observational studies  to  examine the  use  of ICS  in  COVID-19. A  rigorous  blinded randomized multicentric  clinical trials  are  urgently needed  to  further conclusion  verification  for the  harm  or the benefit  of  corticosteroid  treatment with confidence.    

Volume 1 Issue 2 October 2020

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