Myths and facts about the application of corticosteroids in patients diagnosed with COVID-19

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Myths and facts about the application of corticosteroids in patients diagnosed with COVID-19

Journal Title: Revista científica estudiantil 2 de Diciembre - Year 2022, Vol 5, Issue 1

Abstract

The pandemic caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), the causative agent of COVID-19, has been spreading around the world for more than a year. Pathophysiologically, the virus infects host cells by recognizing the angiotensin converting enzyme 2 (ACE2), which is present in different tissues and organs such as lung, heart, blood vessels, kidneys and intestines; for this reason, a person infected with COVID-19 can present affectations in any of these organs, although, most of the time, severe infection is related to damage at the pulmonary epithelium level (1). COVID-19 has caused the death of millions of people, while many others have been infected, developing from asymptomatic infections to severe or critical manifestations. Patients who have suffered from the disease, especially in its most severe forms, often present short- and medium-term sequelae, which are part of the so-called post-COVID-19 syndrome. In view of this situation, a race has begun around the world in search of an effective treatment to combat the infection and a vaccine to prevent contagion. Therefore, many healthcare centers have begun studies and tests with different drugs, some with more success than others, which, added to the great media coverage of the world health situation, has led to the creation of certain myths about the efficacy of some compounds in the treatment of the virus and its manifestations, such as hydroxychloroquine, ivermectin and corticoids, which have been the most promising so far. The use of corticosteroids, as systemic anti-inflammatory drugs, in patients with COVID-19 is justified by the increase in markers of inflammation that occur during the disease, which is related to a worse prognosis and a greater likelihood of developing acute respiratory distress syndrome, which sometimes proves fatal (2). Among the clinical trials evaluating the effectiveness of corticosteroids and more specifically, dexamethasone, in the treatment of COVID-19, RECOVERY has been the most promising, as it evaluated the effects caused by the administration of 6 mg of dexamethasone once daily (orally or intravenously) for up to 10 days in 6425 patients hospitalized for symptomatic COVID-19 infection, in the United Kingdom. At the time of randomization, 16% were receiving invasive mechanical ventilation or extracorporeal membrane oxygenation; 60% were receiving oxygen only and 24% were receiving neither (3). In analyzing the results, experts suggested that the relative effectiveness of systemic corticosteroids varied proportionally depending on the level of respiratory support received at the time of randomization (3). In a meta-analysis coordinated by the World Health Organization (WHO), analyzing data from the subgroup of mechanically ventilated patients in the RECOVERY trial together with data from six other clinical trials that have included critically ill patients from COVID-19, it was concluded that systemic corticosteroid therapy, in critically ill patients, compared to no corticosteroid treatment, probably reduces the risk of 28-day mortality, results similar to those shown for the subgroup of non-critically ill severe COVID-19 patients (2,3). For the group of patients with non-critical COVID-19, systemic corticosteroids may increase the risk of 28-day mortality, according to preliminary results (3). Data on the efficacy of corticosteroids other than dexamethasone are limited to small trials, several of which had to be stopped early. However, other corticosteroids have been proposed as therapeutic alternatives at equivalent doses in case dexamethasone is not available or intolerance and hypersensitivity to dexamethasone occurs (4). Although the studies on the use of corticosteroids in the treatment of COVID-19 in severe and critical patients are promising, most of them have been influenced by the RECOVERY study in the United Kingdom, and others are limited only to the use of dexamethasone, which raises questions regarding the possibility of use and efficacy of other drugs belonging to this group, in addition to the fact that they are all relatively recent, so it has not been possible to determine aspects such as: duration of treatment, short- and long-term adverse effects and effect on the sequelae left by SARS-CoV-2 infection. Despite this, social networks have been flooded with false information that assures the existence of a treatment for COVID-19 based on studies of dubious origin or that do not yet have sufficient evidence to reach a conclusion. It is therefore necessary to call on health personnel not to guide therapeutic decisions by anecdotal data and biases and to be guided only by data published in official sources for medical dissemination, complying with the standards of good medical practice and the development of evidence-based medicine.

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EP ID EP702496
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