Place of Corticosteroids in the Treatment of Coronavirus Disease 2019
Journal of pathology and infectious diseases
The precise role of corticosteroids for the treatment of coronavirus disease 2019 is unclear due to lack of randomized trials. Objective: The objective of the study was to review the therapeutic value of corticosteroids in hospitalized patients with COVID-19. Methods: English literature search of electronic databases supplemented by manual search up to July 5, 2020. Search terms included corticosteroids, COVID-19, dexamethasone, methylprednisolone, hydrocortisone, mortality, and safety.
... and safety. Randomized trials were the main focus of research, but observational studies were also reviewed. Results: Preliminary data from the only available randomized trial in COVID-19, the "Randomized Evaluation of COVID-19 therapy" (RECOVERY) trial, showed that dexamethasone 6 mg/day for up to 10 days reduced 28-day mortality (the primary outcome) in hospitalized patients with COVID-19 by 17%, adjusted rate ratio (RR) 0.83, and 95% confidence interval (CI) 0.74-0.92 (P < 0.001). The highest magnitude of mortality reduction was observed among patients receiving mechanical ventilation, RR 0.65, 95% CI; 0.51-0.82 (P < 0.001), followed by patients receiving oxygen without mechanical ventilation, RR 0.80, 95% CI, 0.70-0.92 (P = 0.002). However, there was a non-significant trend toward increase mortality in patients not receiving respiratory support, RR 1.22, 95% CI, 0.93-1.61 (P = 0.14). A smaller randomized study (n = 277) showed that dexamethasone decreased 60-day mortality in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), but without COVID-19. These latter results may be pertinent to COVID-19, in which ARDS is a common complication. Conclusions: The dexamethasone treatment protocol of the RECOVERY trial should be implemented for the treatment of patients with COVID-19 receiving mechanical ventilation or oxygen. Meanwhile, corticosteroids should not be used in milder cases that do not require oxygen due to a possible harm.