Steroids in COVID-19: An overview

Kshitij Chatterjee; Chao-Ping Wu; Abhishek Bhardwaj; Matthew Siuba

doi:10.3949/ccjm.87a.ccc059

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TABLE 1

Society recommendations on the use of corticosteroids in patients with COVID-19–related respiratory illness (as of 7/19/2020)

Surviving Sepsis Campaign²² (3/28/2020

• In mechanically ventilated adults with COVID-19 and respiratory failure (without ARDS), we suggest against the routine use of systemic corticosteroids. (Weak recommendation, low-quality of evidence)
• In mechanically ventilated adults with COVID-19 and ARDS, we suggest using systemic corticosteroids over not using corticosteroids. (Weak recommendation, low-quality of evidence)

American Thoracic Society COVID-19: Interim Guidance²³ (4/3/2020)

• For hospitalized patients with COVID-19 who have evidence of pneumonia, we make no suggestion either for or against treatment with systemic corticosteroids: 15% for intervention; 18% no suggestion; 67% against intervention. (Evidence not available)

Infectious Diseases Society of America²⁴ (6/25/2020)

• Among hospitalized patients with severe^a COVID-19, suggests glucocorticoid rather than no glucocorticoids. (Conditional recommendation, moderate certainty of evidence)
• Among hospitalized patients with COVID-19 without hypoxemia requiring supplemental oxygen, suggests against the use of glucocorticoid. (Conditional recommendation, low certainty of evidence)
^aSevere illness is defined as patients with 94% or less SpO₂ on room air, and those who require supplemental oxygen, mechanical ventilation, or ECMO

National Institutes of Health²⁵ (6/25/2020)

• The COVID-19 Treatment Guidelines Panel recommends using dexamethasone (at a dose of 6 mg per day for up to 10 days) for the treatment of COVID-19 in patients who are mechanically ventilated (Strong recommendation) and in patients who require supplemental oxygen but who are not mechanically ventilated (Moderate recommendation).
• The Panel recommends against using dexamethasone for the treatment of COVID-19 in patients who do not require supplemental oxygen. (Strong recommendation)

World Health Organization Interim Guidance²⁶ (5/27/2020)

• Recommends against the routine use of systemic corticosteroids for treatment of viral pneumonia. (Evidence not available)