Corticosteroids have emerged as a significant treatment in the management of severe COVID-19, influencing patient outcomes since the early stages of the pandemic. This article explores their nature, impact on the body’s response to the SARS-CoV-2 virus, the evidence supporting their use, and important considerations for their administration.
Understanding Corticosteroids
Corticosteroids are synthetic medications that mimic hormones naturally produced by the adrenal glands, such as cortisol. They function as anti-inflammatory and immunosuppressive drugs, distinct from anabolic steroids used for muscle building. Corticosteroids reduce the body’s inflammatory response and suppress immune system activity. This makes them useful for treating conditions like asthma, allergies, and autoimmune diseases.
How Corticosteroids Influence COVID-19
In severe COVID-19, the immune system can overreact, leading to an uncontrolled systemic inflammatory response. This excessive inflammation, often called a “cytokine storm,” can damage organs, particularly the lungs, and contribute to acute respiratory distress syndrome (ARDS). Corticosteroids dampen this exaggerated immune activity. They reduce pro-inflammatory cytokines and chemokines, which drive the inflammatory cascade. By inhibiting these pathways, corticosteroids help protect lung tissue and other organs from immune-mediated injury, preventing progression to critical stages.
Evidence of Patient Outcomes
Clinical trials provide substantial evidence for corticosteroid use in COVID-19. The RECOVERY trial, a large randomized clinical trial, demonstrated that low-dose dexamethasone significantly reduced mortality in hospitalized patients with severe respiratory complications. Dexamethasone reduced deaths by one-third in patients requiring mechanical ventilation and by one-fifth in those receiving oxygen alone.
These benefits were observed in severely ill patients needing respiratory support. Corticosteroids are not for everyone; patients with mild COVID-19 who do not require oxygen showed no benefit and it may even be harmful. A meta-analysis of several clinical trials further supported that systemic corticosteroids were associated with lower 28-day mortality in patients with low oxygen levels. Studies also indicated that corticosteroids can reduce in-hospital mortality among patients with severe and critical COVID-19, including those on invasive mechanical ventilation. The consistent findings from these studies led to widespread recommendations for corticosteroids like dexamethasone as a standard of care for severely ill COVID-19 patients.
Important Considerations for Treatment
Corticosteroids require careful medical supervision. Their use is recommended for patients with severe or critical COVID-19 who exhibit signs of pneumonia, severe respiratory distress, or low blood oxygen levels. Self-medication is not advised and can be dangerous, potentially increasing the risk of infection if the person does not have an existing severe illness.
Corticosteroids can lead to various side effects, which tend to increase with higher doses and longer durations of use. Common side effects include elevated blood sugar levels, increased risk of secondary infections, fluid retention, high blood pressure, and mood changes. Prolonged use, typically beyond two weeks, may lead to more serious issues like glaucoma, cataracts, and bone thinning.
Healthcare professionals determine the appropriate dosage and duration based on individual patient circumstances and monitor for potential adverse effects. The benefits of corticosteroids in severe COVID-19 are considered to outweigh these risks when administered under medical guidance.