Esteroides y COVID-19: una revisión de la evidencia en crecimiento durante la pandemia

Gestne Aure; Fernando Carrera-Viñoles; Zully Andreina Requiz; María Morante; Julio Rodríguez

Authors

Gestne Aure
Fernando Carrera-Viñoles
Zully Andreina Requiz
María Morante
Julio Rodríguez

Keywords:

Steroids, COVID -19, Dexamethasone, SARS-CoV2.

Abstract

The specific mechanism by which steroids would act on sustained lung inflammation, as well as the definition of the best drug to use and the appropriate treatment duration remain to be the objectives of ongoing clinical trials. As clinicians, we believe that the potent anti-inflammatory properties of synthetic steroids are well defined and definitive evidence that other anti-inflammatory strategies provide better efficacy is still lacking, at least in COVID-19. Although synthetic steroids share a pronounced anti-inflammatory action and few mineralocorticoid effects, their bioequivalence and different kinetics should be considered, due to the high variability of individual pharmacokinetics, the appropriate use and prescription of these drugs, given that they could trigger various effects that could negatively impact the clinical course of the patient with COVID-19. In addition, many of the drugs currently considered in the management of the patient with this disease can enhance the half-life and appearance of adverse effects of corticosteroids and some adverse effects of these other drugs can simulate complications associated with the use of corticosteroids, which could lead to an early and untimely suspension of them. Numerous clinical studies and study articles based on narrative reviews have served as guides for clinicians in the midst of this pandemic; however, the results of these should be interpreted with caution. For these reasons, we have performed an analysis based on the GRADE system of these studies to contrast the information included in the clinical studies and minimize the error of analysis.

Downloads

Download data is not yet available.

References

Tang NL-S, Chan PK-S, Wong C-K, et al. Enhanced expression of interferon-inducible protein-10 (CXCL-10) and other chemokines predicts adverse outcome in severe acute respiratory syndrome. Clin Chem. 2005; 55: 2333–2340.

Pang BS, Wang Z, Zhang LM, Tong ZH, Xu LL, Huang XX, Guo WJ, Zhu M, Wang C, Li XW, He ZP. Dynamic changes in blood cytokine levels as clinical indicators in severe acute respiratory syndrome. Chinese medical journal. 2003; 116(9).

Arabi YM, Balkhy HH, Hayden FG, et al. Middle East respiratory syndrome. N Engl J Med. 2017; 376: 584–94.

Waterer, Grant W., and Jordi Rello. "Steroids and COVID-19: we need a precision approach, not one size fits all." Infect Dis Ther. 2020; 16: 1-5.

Shang L, Zhao J, Hu Y, Du R, Cao B. On the use of corticosteroids for 2019-CoV pneumonia. Lancet. 2020; 29;395(10225):683.

Lewis SR, Pritchard MW, Thomas CM, Smith AF. Pharmacological agents for adults with acute respiratory distress syndrome. Cochrane Database of Systematic Reviews. 2019; 7.

RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in hospitalized patients with COVID-19—preliminary report. The RECOVERY Trial.. N Engl J Med.. 2020.

SFrancesco Salton, Paola Confalonieri, G Umberto Meduri, Pierachille Santus, Sergio Harari, Raffaele Scala et al. "Prolonged low-dose methylprednisolone in patients with severe COVID-19 pneumonia." Open forum infectious diseases. 2020; 7(10).

Villar, Jesús, et al. "Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial." The Lancet Respiratory Medicine. 2020; 8(3): 267-276.

Tomazini, Bruno M., et al. "Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: the CoDEX randomized clinical trial." Jama. 2020; 324(13): 1307-1316.

Jeronimo CM, Farias ME, Val FF, Sampaio VS, Alexandre MA, Melo GC, Safe IP, Borba MG, Netto RL, Maciel AB, Neto JR. Methylprednisolone as Adjunctive Therapy for Patients Hospitalized With Coronavirus Disease 2019 (COVID-19; Metcovid): A Randomized, Double-blind, Phase IIb, Placebo-controlled Trial. Clinical Infectious Diseases. 2020.

Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, Lim WS. Corticosteroids as adjunctive therapy in the treatment of influenza.. Cochrane Database Syst Rev. 2016; 3.

Yu, He, et al.. "Can corticosteroids improve the outcomes of patients with Covid-19? A retrospective cohort study of patients within and outside the epicentre." Research Square. 2020.

Li Q, Li W, Jin Y, Xu W, Huang C, Li L, Huang Y, Fu Q, Chen L. Efficacy Evaluation of Early, Low-Dose, Short-Term Corticosteroids in Adults Hospitalized with Non-Severe COVID-19 Pneumonia: A Retrospective Cohort Study. Infectious diseases and therapy. 2020; 9: 823–836.

Nicolaides NC, Pavlaki AN, Alexandra MA, Chrousos GP. Glucocorticoid therapy and adrenal suppression. InEndotext [Internet] 2018 Oct 19. MDText. com, Inc. [Online].

Scaroni C, Armigliato M, Cannavò S. COVID-19 outbreak and steroids administration: are patients treated for Sars-Cov-2 at risk of adrenal insufficiency?. J Endocrinol Invest. 2020; 43(7): 1035-1036.

Ramiro S, Mostard RL, Magro-Checa C, Van Dongen CM, Dormans T, Buijs J, Gronenschild M, De Kruif MD, Van Haren EH, Van Kraaij T, Leers MP. Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study. 2020; 79(9).

Fadel R, Morrison AR, Vahia A, et al.. Early short course corticosteroids in hospitalized patients with COVID-19. Clin Infect Dis. 2020.

Ferraù F, Ceccato F, Cannavò S, Scaroni C. What we have to know about corticosteroids use during Sars-Cov-2 infection. Journal of endocrinological investigation. 2020; 28: 1-9.

Mebrahtu TF, Morgan AW, Kelley A, Baxter PD, Stewart PM, Pujades-Rodriguez M. Dose dependency of iatrogenic glucocorticoid excess and adrenal insufficiency and mortality: a cohort study in England. J Clin Endocrinol Metab. 2019; 104(9): 3757-3767.

Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, Zhang L, Zhou X, Du C, Zhang Y, Song J. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA internal medicine. 2020; 180(7): 934–943.

Fernandez-Cruz A, Ruiz-Antoran B, Munoz-Gomez A, et al.. A retrospective controlled cohort study of the impact of glucocorticoid treatment in SARS-CoV-2 infection mortality.. Fernandez-Cruz A, Ruiz-Antoran B, Munoz-Gomez A, et al. A retrospective controlled cohort study of the impact of glucocorticoid treatment in SARS-CoV-2 infection mortality. Antimicrob Agents Chemother. 2020; 64(9).

Yang Z, Liu J, Zhou Y, Zhao X, Zhao Q, Liu J. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis. J Infect. 2020; 81(1).

Corral L, Bahamonde A, Arnaiz de las Revillas F, et al. GLUCOCOVID: A controlled trial of methylprednisolone in adults hospitalized with COVID-19 pneumonia. medRxiv. 2020.

Lu X, Chen T, Wang Y, Wang J, Yan F. Adjuvant corticosteroid therapy for critically ill patients with COVID-19. Critical Care. 2020; 24(1): 1-4.

Isidori AM, Arnaldi G, Boscaro M, Falorni A, Giordano C, Giordano R, Pivonello R, Pozza C, Sbardella E, Simeoli C, Scaroni C, Lenzi A. Towards the tailoring of glucocorticoid replacement in adrenal insufficiency: the Italian Society of Endocrinology Expert Opinion. J Endocrinol Invest. 2020 ; 43(5): 683-696.

Keller MJ, Kitsis EA, Arora S, Chen JT, Agarwal S, Ross MJ, Tomer Y, Southern W. Effect of Systemic Glucocorticoids on Mortality or Mechanical Ventilation in Patients With COVID-19. Journal of hospital medicine. 2020; 1(15): 489-93.

Wang Y, Jiang W, He Q, Wang C, Wang B, Zhou P, Dong N, Tong Q.. Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-center experience from Wuhan,. medRxiv. 2020.

Nelson BC, Laracy J, Shoucri S, Dietz D, Zucker J, Patel N, Sobieszczyk ME, Kubin CJ, Gomez-Simmonds A.. Clinical outcomes associated with methylprednisolone in mechanically ventilated patients with COVID-19. Clinical Infectious Diseases. 2020.