Use of corticosteroids in COVID-19 patients vs. acute respiratory distress syndrome of other etiologies : are there any differences ?

Abstract EN

The disease resulting from infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), widely known as coronavirus disease 2019 (COVID- 19), has been classified as a global pandemic.

It is characterized by respiratory compromise, which may include multisystemic involvement due to endothelial damage as well as activation of multiple thromboin- flammatory mechanisms,1,2 leading to various serious clinical stages such as multiple organ failure and death due to Acute Respiratory Distress Syndrome (ARDS).1 In addition, the increased demand for health services, including the need for intensive care units and advanced vital resources such as mechanical venti- lation or extracorporeal membrane oxygenation and trained personnel, poses serious challenges in choosing a suitable treatment.3,4 In the absence of a standard treatment, the clinical approach to those affected has focused on pharma- cological management, particularly the use of antivirals and immunomodulators.5 According to the phases of the immunological response,6 the use of glucocorticoids has become widespread given its effect on the control of the inflammatory cascade from its origin (blockade of phospholipase A2) to its wide pharmacological availability and low cost.

To date, the results have been controversial.

At the beginning of the pandemic, these drugs were not recommended for use in COVID-19 patients.7 Nonetheless, current preliminary results of a clinical trial in the RECOVERY group show a decrease in mortality in patients receiving dexamethasone,8 raising the possibility of the systematic use of glucocorticoids for COVID-19 disease.9 The purpose of this review is to perform a rapid assessment of the evidence for and against the use of glucocorticoids to prevent progression to ARDS and related mortality in both COVID-19 and ARDS mediated by other pathologies.