Corticosteroids are a class of powerful anti-inflammatory medications used for various conditions. These agents are distinct from anabolic steroids, often associated with muscle building. Their use in managing COVID-19 is specific, not a universal remedy for all infected individuals. The decision to use these medications depends on a patient’s condition and the stage of their illness.
How Steroids Combat COVID-19 Inflammation
In severe cases of COVID-19, the body’s immune system can overreact to the SARS-CoV-2 virus, causing a “cytokine storm.” This involves the uncontrolled release of large amounts of pro-inflammatory cytokines. These signaling proteins normally fight infection but become damaging when produced in excess. This excessive inflammation can harm various organs, especially the lungs, contributing to acute lung injury and acute respiratory distress syndrome (ARDS). These are major causes of severe illness and death in COVID-19 patients.
Corticosteroids work by suppressing this exaggerated immune response, thereby reducing harmful inflammation. They achieve this by decreasing the production of inflammatory cytokines, chemokines, and activated immune cells. These steroids do not directly combat the SARS-CoV-2 virus. Instead, they manage the damaging inflammatory response the virus can trigger. By calming the immune system, corticosteroids help prevent further damage to tissues and organs.
Criteria for Steroid Treatment
Corticosteroid treatment for COVID-19 is reserved for specific patient populations, based on established clinical guidelines. These medications are recommended for patients who are hospitalized and require supplemental oxygen, high-flow nasal cannula, non-invasive ventilation, or mechanical ventilation. The benefit of corticosteroids has been observed in these sicker patients, showing a reduction in mortality.
Conversely, corticosteroids are not recommended for patients with mild to moderate COVID-19 who do not require oxygen support. In the early stages of infection, a robust immune response is necessary for the body to effectively fight and clear the virus. Suppressing this immune response with steroids in non-severe cases could be counterproductive, hindering the body’s natural ability to overcome the infection.
Types of Steroids and Administration
Dexamethasone is the most extensively studied and commonly used corticosteroid for treating COVID-19. Its widespread adoption stems from the significant findings of the RECOVERY trial, a large clinical trial conducted in the United Kingdom. This trial demonstrated that a low dose of dexamethasone (6 mg daily) significantly reduced deaths by up to one-third in hospitalized patients requiring oxygen or mechanical ventilation. This evidence led to dexamethasone becoming a standard of care globally for severe COVID-19.
While dexamethasone is the primary choice, other corticosteroids such as prednisone, methylprednisolone, or hydrocortisone may be used as alternatives, often in equivalent dosages. These medications can be administered in a hospital setting either orally as a pill or intravenously (IV) as an injection or infusion. The choice of administration method depends on the patient’s condition and specific clinical circumstances.
Potential Side Effects and Monitoring
While corticosteroids offer significant benefits in severe COVID-19, their use can be associated with certain short-term side effects. One common metabolic effect is elevated blood sugar levels (hyperglycemia), requiring careful monitoring, especially in patients with pre-existing diabetes.
Patients may also experience psychiatric effects, including insomnia, agitation, or mood swings. These effects are transient and are managed by the medical team. Additionally, corticosteroids have immunosuppressive qualities, which can temporarily increase the risk of secondary infections. Due to these potential effects, patients receiving corticosteroid treatment are continuously monitored by healthcare professionals to detect and address any adverse reactions.