ISSN: 2642-1143
Authors: Mikhail N* and Wali S
Background: The precise role of glucocorticoids for treatment of coronavirus disease 2019 (COVID-19) is unclear. Objective: 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 27, 2020. Search terms included glucocorticoids, corticosteroids, COVID-19, ARDS, dexamethasone, methylprednisolone, hydrocortisone, mortality, safety. Randomized trials, observational studies and major organization guidelines were included. Results: Preliminary data from the only available large 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, 95% CI 0.75 to 0.93 (P < 0.001). The highest magnitude of mortality reduction was observed among patients receiving invasive mechanical ventilation, RR 0.64, 95% CI; 0.51 to 0.81 (P < 0.001), followed by patients receiving oxygen without mechanical ventilation, RR 0.82, 95% CI, 0.72 to 0.94 (P= 0.002). However, there was a non-significant trend toward increase mortality in patients not receiving respiratory support, RR 1.19, 95% CI, 0.91 to 1.55. 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: Dexamethasone 6 mg/d for up to 10 days should be included in treatment of patients with COVID-19 receiving invasive mechanical ventilation or oxygen. Meanwhile, dexamethasone should not be used in milder cases that do not require oxygen due to a possible harm.
Keywords: COVID-19; Dexamethasone; Glucocorticoids; Mortality; Mechanical ventilation; ARDS
