Experts are not against the use of glucocorticoids in sick and critically ill COVID-19 patients
The number of COVID-19 cases in India reached 190535 (till June 1, 2020 08.00 AM) with 5394 deaths. Figures of new cases are hitting new highs daily but case fatality rates are low when compared to the global scenario.
Till date, no drug has been proven to be safe and effective for treating COVID-19. Most patients require only supportive therapy. But treatment of sick patients with low oxygen saturation levels who require oxygen supplementation and mechanical ventilators for supporting their breathing are the areas of greatest focus.
Use of antiviral or immunomodulatory therapy in patients with COVID-19 are also being tried in such sick patients. Some patients worsen to develop acute respiratory distress and shock with multi-organ failure (low blood pressure unable to maintain perfusion to vital organs) leading to death. ARDS or acute respiratory distress syndrome refers to acute inflammation and injury to the lung leading to respiratory failure. Clinicians around the world are scrutinizing evidence to prevent this cascade of lung inflammation and injury.
The Society of Critical Care Medicine (SCCM) panel issued a suggestion recently against the routine use of systemic corticosteroids for respiratory failure in COVID-19, but favours the use of corticosteroids in the sicker population of COVID-19 with ARDS
Glucocorticoids are the most commonly used anti-inflammatory and immunomodulatory drugs. Studies that investigated the role of glucocorticoids in ARDS have yielded inconsistent results, especially in ARDS due to viral infections. However, recent guidelines from leading expert panels indicate that low-dose glucocorticoid therapy, when initiated at an early stage, was associated with reduced mortality.
The Society of Critical Care Medicine (SCCM) panel issued a suggestion recently against the routine use of systemic corticosteroids for respiratory failure in COVID-19, but favours the use of corticosteroids in the sicker population of COVID-19 with ARDS. They recommend using lower dosage and shorter treatment courses. This was consistent with the guidelines of the European Society of Intensive Care Medicine (ESICM) 2017.
However, recommendation from Centers for Disease Control and Prevention (CDC), USA reserves the use of glucocorticoids only in intensive care settings, especially for adults with COVID-19 and refractory shock (shock not improving with conventional treatment).
Reports from Yuhuan, China also showed benefits of glucocorticoid use in treatment of sick COVID-19 patients.
Indian guidelines are also in favour of early low-dose glucocorticoid therapy in people with respiratory failure. Dr. Nikhil Modi, Senior consultant, Respiratory and Critical Care Medicine at Indraprastha Apollo Hospitals said, “We have been using low-dose corticosteroids in COVID-19 patients with hypoxia (low oxygen saturation) leading to faster recovery. Corticosteroid use in critically ill COVID-19 patients with ARDS (on ventilator support) also hastens recovery when started early.”
