Meagan Johns1, Stephy George2, Margarita Taburyanskaya2, Yi Kee Poon1. 1. Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, TX, USA. 2. Department of Pharmacy, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, TX, USA.
Abstract
OBJECTIVE: To review available evidence on corticosteroids in acute respiratory distress syndrome (ARDS), Coronavirus Disease 2019 (COVID-19), and other viral pneumonias. DATA SOURCES: A literature search of MEDLINE, PubMed and clinicaltrials.gov was performed to identify studies between 1980 to 2020 using the following search terms: corticosteroids, COVID19, severe respiratory syndrome coronavirus 2 (SARS-CoV-2), Middle East respiratory syndrome-related coronavirus (MERS-CoV), and influenza. Pre-printed articles were also reviewed at medRxiv.org. DATA ANALYSIS: Corticosteroids were not recommended early in the COVID-19 pandemic outside of the use for concomitant indications (i.e. ARDS, septic shock) as they have been associated with delayed time to viral clearance in other viral pneumonias. A randomized trial showed a mortality benefit with dexamethasone in COVID-19. Guidelines have been updated to include a strong recommendation for their use in COVID-19 in those hospitalized requiring supplemental oxygen or mechanical ventilation. CONCLUSION: Based on data from available randomized trials, patients that require respiratory support or mechanical ventilation benefit from corticosteroid therapy. Corticosteroids are an inexpensive and readily available therapy that should be standard of care in hospitalized COVID-19 patients requiring respiratory support.
OBJECTIVE: To review available evidence on corticosteroids in acute respiratory distress syndrome (ARDS), Coronavirus Disease 2019 (COVID-19), and other viral pneumonias. DATA SOURCES: A literature search of MEDLINE, PubMed and clinicaltrials.gov was performed to identify studies between 1980 to 2020 using the following search terms: corticosteroids, COVID19, severe respiratory syndrome coronavirus 2 (SARS-CoV-2), Middle East respiratory syndrome-related coronavirus (MERS-CoV), and influenza. Pre-printed articles were also reviewed at medRxiv.org. DATA ANALYSIS: Corticosteroids were not recommended early in the COVID-19 pandemic outside of the use for concomitant indications (i.e. ARDS, septic shock) as they have been associated with delayed time to viral clearance in other viral pneumonias. A randomized trial showed a mortality benefit with dexamethasone in COVID-19. Guidelines have been updated to include a strong recommendation for their use in COVID-19 in those hospitalized requiring supplemental oxygen or mechanical ventilation. CONCLUSION: Based on data from available randomized trials, patients that require respiratory support or mechanical ventilation benefit from corticosteroid therapy. Corticosteroids are an inexpensive and readily available therapy that should be standard of care in hospitalized COVID-19 patients requiring respiratory support.
Authors: Rodrigo Alonso; Ana M Camon; Francisco J Muñoz; Celia Cardozo; Javier Bernal-Maurandi; Laia Albiach; Daiana Agüero; M Angeles Marcos; Juan Ambrosioni; Marta Bodro; Mariana Chumbita; Lorena De la Mora; Nicole Garcia-Pouton; Gerard Dueñas; Marta Hernandez-Meneses; Alexy Inciarte; Genoveva Cuesta; Fernanda Meira; Laura Morata; Pedro Puerta-Alcalde; Verónica Rico; Sabina Herrera; Montse Tuset; Pedro Castro; Sergio Prieto-González; Alex Almuedo; José Muñoz; Josep Mensa; Gemma Sanjuan; J M Nicolas; Ana Del Rio; Jordi Vila; Felipe García; José Antonio Martínez; Carolina Garcia-Vidal; Alex Soriano Journal: Sci Rep Date: 2022-03-28 Impact factor: 4.379