A critical evaluation of glucocorticoids in the management of severe COVID-19

Cytokine Growth Factor Rev. 2020 Aug:54:8-23. doi: 10.1016/j.cytogfr.2020.06.012. Epub 2020 Jun 24.

Abstract

The viral infection by SARS-CoV-2 has irrevocably altered the life of the majority of human beings, challenging national health systems worldwide, and pushing researchers to rapidly find adequate preventive and treatment strategies. No therapies have been shown effective with the exception of dexamethasone, a glucocorticoid that was recently proved to be the first life-saving drug in this disease. Remarkably, around 20 % of infected people develop a severe form of COVID-19, giving rise to respiratory and multi-organ failures requiring subintensive and intensive care interventions. This phenomenon is due to an excessive immune response that damages pulmonary alveoli, leading to a cytokine and chemokine storm with systemic effects. Indeed glucocorticoids' role in regulating this immune response is controversial, and they have been used in clinical practice in a variety of countries, even without a previous clear consensus on their evidence-based benefit.

Keywords: ARDS; COVID-19; Glucocorticoids; Immune response; SARS-CoV-2.

Publication types

  • Review

MeSH terms

  • Anti-Inflammatory Agents / therapeutic use*
  • Antiviral Agents / therapeutic use
  • Betacoronavirus / drug effects
  • COVID-19
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / pathology
  • Cytokine Release Syndrome / drug therapy*
  • Dexamethasone / therapeutic use*
  • Glucocorticoids / therapeutic use*
  • Humans
  • Pandemics
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / pathology
  • Pulmonary Alveoli / pathology
  • SARS-CoV-2

Substances

  • Anti-Inflammatory Agents
  • Antiviral Agents
  • Glucocorticoids
  • Dexamethasone