What is the role of corticosteroids in the treatment of COVID-19?

Updated: Jan 12, 2021
  • Author: Setu K Patolia, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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In March 2020, the WHO recommended against routine use of systemic corticosteroids in patients with ARDS secondary to SARS-CoV2 infection, unless otherwise indicated. This recommendation was largely based on data available on the use of corticosteroids in the management of Middle East respiratory syndrome, severe acute respiratory syndrome, seasonal influenza, and respiratory syncytial virus infections. [49]

Later, the controlled, open-label Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial of dexamethasone in patients hospitalized with COVID-19 was published. This trial was conducted on hospitalized patients across 176 National Health Service organizations. Patients were randomized to receive 6 mg of oral or intravenous dexamethasone for 10 days versus the usual care. Among patients hospitalized for SARS-CoV2 infection, use of dexamethasone resulted in lower 28-day mortality in patients on oxygen supplementation or invasive mechanical ventilation. No benefit and a possibility of harm was noted in patients not on oxygen supplementation at the time of randomization. Patients with longer duration of symptoms (>7 days) had greater benefit from dexamethasone therapy. It was also shown to reduce the median duration of hospital stay and clinical progression to respiratory decompensation in patients on supplemental oxygen. [50]

Patients treated with corticosteroids in the setting of Middle East respiratory syndrome, severe acute respiratory syndrome, and influenza showed slower viral clearance. [51, 52, 53] The clinical implication of this finding is unknown. However, in SARS-CoV2 infection, the viral shedding tends to decline over time and use of dexamethasone is likely more beneficial at a stage of the disease process dominated by immunopathological effects than active viral replication. [50]

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