To the editor
We read with interest the recently published systematic review and meta-analysis authored by Pei et al,1 which provides top level evidence regarding the impact of drug therapy on odds for death in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Notably, Pei et al1 demonstrated that the use of glucocorticoids is associated with an increase in the odds for death in the context of the disease, bringing into question the use of this drug class in SARS-CoV-2 infection.
In another recent systematic review and meta-analysis, it was shown that corticosteroid use in patients infected with coronaviruses (severe acute respiratory syndrome coronavirus [SARS], Middle East respiratory syndrome coronavirus [MERS], or SARS-CoV-2) did not increase the odds for death, while, in a time-adjusted analysis according to risk factors such as age or comorbidities, corticosteroids were associated with a decrease in the risk of death.2
Of note, in the randomized, open-label RECOVERY study enrolling hospitalized patients with SARS-CoV-2 infection, dexamethasone was shown to decrease the rate of death by 36% in patients receiving mechanical ventilation and by 18% in those receiving oxygen supplementation without mechanical ventilation, compared with placebo.3 In a real world study conducted in France enrolling hospitalized patients with SARS-CoV-2 infection, it was demonstrated that initiation of corticosteroids in the treatment protocol of SARS-CoV-2 pneumonia was associated with a 53% decrease in the risk of death and a 63% decrease in the risk of intensive care unit admission or death before intensive care unit admission.4
Thus, despite the fact that in other cases of viral pneumonia such as influenza pneumonia corticosteroid use is not recommended and might increase mortality indeed,5 it seems that we have a long journey to go in the COVID-19 pandemic era. More data are required in order to elucidate the role of corticosteroid treatment in the context of SARS-CoV-2 infection.
Dimitrios Patoulias, Christodoulos Papadopoulos, Alexandra Katsimardou, Maria Toumpourleka, Michael Doumas (DP, AK, and MD: Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital “Hippokration,” Greece; CP and MT: 3rd Department of Cardiology, Aristotle University of Thessaloniki, General Hospital, “Hippokration,” Greece; MD: Veterans Affairs Medical Center, George Washington University, Washington, District of Columbia, United States)
Dimitrios Patoulias, MD, MSc, Second Propedeutic Department of Internal Medicine, General Hospital “Hippokration,” Konstantinoupoleos 49, 54 642, Thessaloniki, Greece, phone: +30 6 946 900 777, email: firstname.lastname@example.org
Patoulias D, Christodoulos P, Katsimardou A, et al. Use of corticosteroids in SARS-CoV-2 infection: foe, or can they become a friend? Pol Arch Intern Med. 2020; 130: 922. doi:10.20452/pamw.15661
- Pei L, Zhang S, Huang L, et al. Antiviral agents, glucocorticoids, antibiotics, and intravenous immunoglobulin in 1142 patients with coronavirus disease 2019: a systematic review and meta-analysis. Pol Arch Intern Med. 2020; 130: 726-733.Crossref
- Lee KH, Yoon S, Jeong GH, et al. Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis. J Clin Med. 2020; 9: E2392.
- RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report. N Engl J Med. 2020 Jul 17. [Epub ahead of print].
- Bani-Sadr F, Hentzien M, Pascard M, et al. Corticosteroid therapy for patients with COVID-19 pneumonia: a before-after study. Int J Antimicrob Agents. 2020; 56: 106077.Crossref
- Ni YN, Chen G, Sun J, Liang BM, Liang ZA. The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis. Crit Care. 2019; 23: 99.Crossref