Use of glucocorticoids in SARS CoV 2 infection: pros and cons
Keywords:
SARS CoV-2 infection, COVID-19, Glucocorticoids, cytokine storm, efficacy, safetyAbstract
Treatment of SARS CoV-2 infection is a major problem in contemporary medicine caused by the absence of specifi c antiviral drugs. Attempts to use many groups of drugs have had some successes and failures. Th e pathophysiological approach to the rationality of drug use is the basis of the eff ectiveness and safety of treatment. Glucocorticoids are a group of drugs capable of solving health problems in serious and critical situations. Physicians, despite the absence of evidence-based data, continue to use corticosteroids in critical situations based on pharmacological properties and experience. In SARS CoV-2 infection initially, at the beginning of the pandemic, the use of glucocorticoids was not recommended, and later, based on clinical studies, the World Health Organization issued a series of recommendations regarding the rationality of their use through an individualized approach. Th e latter involves determining the timing of initiation, selection of the drug, doses and duration of treatment. Th e key moment in this context is the time of the onset of the cytokine storm (the second week aft er the onset of symptoms) on which the administration of glucocorticoids is directed
References
1. Ahmed M.H., Hassan A. Dexamethasone for the Treatment of Coronavirus Disease (COVID-19): a Review. In: SN Compr. Clin. Med. 2020 Oct 31:1-10. doi: 10.1007/s42399-020-00610-8. Epub ahead of print. PMID: 33163859; PMCID: PMC7599121.
2. Alessi J., de Oliveira G.B., Schaan B.D. et al. Dexamethasone in the era of COVID-19: friend or foe? An essay on the eff ects of dexamethasone and the potential risks of its inadvertent use in patients with diabetes. In: Diabetol. Metab. Syndr. 2020 Sep 7;12: 80. https://doi.org/10.1186/s13098-020-00583-7
3. Burrage D.R., Koushesh S., Sofat N. Immunomodulatory Drugs in the Management of SARS-CoV-2. In: Front. Immunol. 2020 Aug 13;11: 1844. PMID: 32903555; PMCID: PMC7438578. https://doi.org/10.3389/fimmu.2020.01844
4. Choudhary S., Sharma K., Silakari O. The interplay between infl ammatory pathways and COVID-19: A critical review on pathogenesis and therapeutic options. In: Microb. Pathog. 2020 Dec 2;150: 104673. https://doi.org/10.1016/j.micpath.2020.104673
5. European Medicines Agency. Dexamethasone in hospitalised patients with COVID-19. EMA/509632/2020.17 September 2020. Procedure number: EMEA/H/A5(3)/1500.
6. Halacli B., Topeli A. Treatment of the Cytokine Storm in COVID-19. In: J. Crit. Intensive Care. 2020; 11(Suppl. 1): 36−40.
https://doi.org/10.37678/dcybd.2020.2434
7. Ismini A.V., Holger H. The Role of Glucocorticoids in the Management of COVID-19 Playlist. In: Hormone and Metabolic Research 2020.
https://doi.org/10.1055/a-1300-2550
8. Kronbichler A., Eff enberger M., Eisenhut M. et al. Seven recommendations to rescue the patients and reduce the mortality from COVID-19 infection: An immunological point of view. In: Autoimmun Rev. 2020 Jul; 19(7): 102570. https://doi.org/10.1016/j.autrev.2020.102570
9. Lam S., Lombardi A., Ouanounou A. COVID-19: A review of the proposed pharmacological treatments. In: Eur. J. Pharmacol. 2020 Nov 5; 886:173451. https://doi.org/10.1016/j.ejphar.2020.173451
10. Lariccia V., Magi S., Serfi lippi T. et al. Challenges and Opportunities from Targeting Inflammatory Responses to SARS-CoV-2 Infection: A Narrative Review. In: J. Clin. Med. 2020 Dec 12; 9(12): 4021. https://doi.org/10.3390/jcm9124021
11. Li L., Li R., Wu Z. et al. Therapeutic strategies for critically ill patients with COVID-19. In: Ann. Intensive Care. 2020 Apr; 10, 45. https://doi.org/10.1186/s13613-020-00661-z
12. Matthay M.A., Thompson B.T. Dexamethasone in hospitalised patients with COVID-19: addressing uncertainties. In: Lancet. Respir. Med. 2020 Dec; 8(12): 1170-1172. https://doi.org/10.1016/S2213-2600(20)30503-8
13. Mehta Y., Dixit S.B., Zirpe K.G. et al. Cytokine Storm in Novel Coronavirus Disease (COVID-19): Expert Management Considerations. In: Indian Journal of Critical Care Medicine (2020): 10.5005/jp-journals10071-23415.
14. Mussini C., Falcone M., Nozza S. et al. Therapeutic strategies for severe COVID-19: a position paper from the Italian Society of Infectious and Tropical Diseases (SIMIT), In: Clinical Microbiology and Infection, 2020, 22 dec., https://doi.org/10.1016/j.cmi.2020.12.011
15. Neupane K., Ahmed Z., Pervez H. et al. Potential Treatment Options for COVID-19: A Comprehensive Review of Global Pharmacological Development Efforts. In: Cureus. 2020 Jun 26; 12(6): e8845. https://doi.org/10.7759/cureus.8845
16. Panettieri R.A., Schaafsma D., Amrani Y. et al. Nongenomic Eff ects of Glucocorticoids: An Updated View. In: Trends Pharmacol. Sci. 2019 Jan; 40(1): 38-49. https://doi.org/10.1016/j.tips.2018.11.002
17. Pasin L., Navalesi P., Zangrillo A. et al. Corticosteroids for Patients With Coronavirus Disease 2019 (COVID19) With Diff erent Disease Severity: A Meta-Analysis of Randomized Clinical Trials. In: Journal of Cardiothoracic and Vascular Anesthesia. 2021; 35: 578-584. https://doi.org/10.1053/j.jvca.2020.11.057
18. Quatrini L., Ugolini S. New insights into the cell-and tissue-specifi city of glucocorticoid actions. In: Cell. Mol. Immunol. (2020). https://doi.org/10.1038/s41423-020-00526-2
19. Quirch M., Lee J., Rehman S. Hazards of the Cytokine Storm and Cytokine-Targeted Therapy in Patients With COVID-19: Review. In: J. Med. Internet Res. 2020 Aug 13; 22(8): e20193. https://doi.org/10.2196/20193
20. Razmi M., Hashemi F., Gheytanchi E. et al. Immunomodulatory-based therapy as a potential promising treatment strategy against severe COVID-19 patients: A systematic review. In: International Immunopharmacology. 2020 November; 88: 106942. https://doi.org/10.1016/j.intimp.2020.106942
21. Rizk J.G., Kalantar-Zadeh K., Mehra M.R. et al. Pharmaco-Immunomodulatory Therapy in COVID-19. In: Drugs. 2020 Sep; 80(13): 1267-1292. https://doi.org/10.1007/s40265-020-01367-z
22. Ruiz-Irastorza G., Pijoan J-I., Bereciartua E. et al. Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: An observational comparative study using routine care data. In: PLoS ONE. 2020; 15(9): e0239401. https://doi.org/10.1371/journal.pone.0239401
23. Sahebnasagh A., Avan R., Saghafi F.et al. Pharmacological treatments of COVID-19. In: Pharmacol Rep. 2020 Aug 20:1-33. https://doi.org/10.1007/s43440-020-00152-9
24. Shyr Z.A., Gorshkov K., Chen C.Z., Zheng W. Drug Discovery Strategies for SARS-CoV-2. In: Journal of Pharmacology and Experimental Therapeutics. 2020 October, 375 (1) 127-138; https://doi.org/10.1124/jpet.120.000123
25. Silva T.F., Tomiotto-Pellissier F., Sanfelice R.A. et al. A 21st Century Evil: Immunopathology and New Therapies of COVID-19. In: Front Immunol. 2020 Oct 27; 11:562264. https://doi.org/10.3389/fimmu.2020.562264
26. Solinas C., Perra L., Aiello M. et al. A critical evaluation of glucocorticoids in the management of severe COVID-19. In: Cytokine Growth Factor Rev. 2020 Aug; 54:8-23. https://doi.org/10.1016/j.cytogfr.2020.06.012
27. Soy M., Keser G., Atagündüz P. et al. Cytokine storm in COVID-19: pathogenesis and overview of anti-infl ammatory agents used in treatment. In: Clin. Rheumatol. 2020 Jul; 39(7): 2085-2094. https://doi.org/10.1007/s10067-020-05190-5
28. Tang Y., Liu J., Zhang D. et al. Cytokine Storm in COVID19: The Current Evidence and Treatment Strategies. In: Front. Immunol. 2020; 11:1708. https://doi.org/10.3389/fimmu.2020.01708
29. Tortajada C., Colomer E., Andreu-Ballester J.C. et al. Corticosteroids for COVID-19 patients requiring oxygen support? Yes, but not for everyone: Eff ect of corticosteroids on mortality and intensive care unit admission in patients with COVID-19 according to patients' oxygen requirements. In: J. Med. Virol. 2020 27 October;1-7. https://doi.org/10.1002/jmv.26635
30. van Paassen J., Vos J.S., Hoekstra E.M. et al. Corticosteroid use in COVID-19 patients: a systematic review and meta-analysis on clinical outcomes. In: Crit. Care. 2020 Dec 14; 24(1):696. https://doi.org/10.1186/s13054-020-03400-9
31. Wu C., Hou D., Du C. et al. Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis. In: Crit. Care. 2020 Nov 10; 24(1):643. https://doi.org/10.1186/s13054-020-03340-4
32. Zhand S., Saghaeian J.M., Mohammadi S. et al. COVID19: The Immune Responses and Clinical Therapy Candidates. In: Int. J. Mol. Sci. 2020 Aug 3;21(15):5559. https://doi.org/10.3390/ijms21155559
33. Yang Li, Xian Zhou, Tao Li et al. Corticosteroid prevents COVID-19 progression within its therapeutic window: a multicentre, proof-of-concept, observational study. In: Emerging Microbes & Infections, 2020; 9:1, 1869-1877, https://doi.org/10.1080/22221751.2020.1807885
34. Ye Q., Wang B., Mao J. The pathogenesis and treatment of the 'Cytokine Storm' in COVID-19. In: Journal of infection. 2020; 80 (6): 607-613. https://doi.org/10.1016/j.jinf.2020.03.037
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