Corticosteroids for COVID-19

Abstract COVID-19 is placing a major burden on healthcare, economy and social systems worldwide owing to its fast spread and unacceptably high death toll. The unprecedented research effort has established the role of a deregulated immune response to the severe acute respiratory syndrome coronavirus 2 resulting in systemic inflammation. Thereafter, the immunomodulatory approach has been place in the top list of the research agenda for COVID-19. Corticosteroids have been used for more than 70 years for modulating immune response in a broad variety of disease. These drugs have been shown to prevent and attenuate the inflammation both in tissues and in the circulation via non-genomic and genomic effects. At the bedside, numerous observational cohorts have been published the past months and have been inconclusive. Randomized controlled trials with subsequent high quality meta-analyses have provided moderate to strong certainty for increased chance of survival and relief from life supportive therapy with corticosteroids given at a dose of 6mg per day of dexamethasone or equivalent doses of hydrocortisone or methylprednisolone. The corticotherapy was not associated with increased risk of bacterial infection or of delayed viral clearance. In daily practice, physicians may be encouraged to use to corticosteroids when managing patients with COVID-19 requiring oxygen supplementation.