Glucocorticoids in the combination therapy of COVID-19

Abstract

Since the early months of the SARS-CoV-2 pandemic, the understanding that severe forms of COVID-19 are associated with systemic inflammation has spurred the medical community to greater efforts to evaluate the effect of numerous anti-inflammatory and immunomodulatory therapies. Corticosteroids have a broad and non-specific anti-inflammatory action; they can interfere with mRNA transcription of inflammatory cytokines, reducing the production of inflammatory mediators. Therefore, the use of glucocorticoids will reduce the complications caused by the cytokine storm. On the other hand, immunosuppression in the respiratory epithelium may delay viral clearance and predispose to secondary infections and clinical deterioration. Therefore, WHO does not currently recommend the routine use of corticosteroids in the treatment of patients with COVID-19. The RECOVERY study showed a reduction in mortality with dexamethasone in patients with COVID-19 hypoxemia, as well as an increase in the number of days without mechanical ventilation among critically ill patients. The REMAP-CAP Committee concluded that among patients with severe COVID-19, treatment with a 7-day course of various hydrocortisone dose versus no hydrocortisone resulted in 93 and 80% chances of eliminating the need for respiratory and cardiac support for 21 days. The results of studies conducted show that there was no statistical difference between steroid use and mortality in patients with COVID-19 in the high dose group, while there was statistical difference in the medium dose group. The less 5 days group showed a strong association between reduced mortality in patients with COVID-19 and steroid use, while there were no statistically significant associations in the 5–7 days group and the more than 7 days group. Inhaled forms of corticosteroids deserve attention given their effectiveness and logical use.