Corticosteroids for COVID-19 (DEFEAT COVID-19)

What is it about?

Approximately 20% of patients with coronavirus disease 2019 (COVID-19) develop severe pneumonia, and some of these patients progress to life-threatening respiratory failure, acute respiratory distress syndrome and multiple organ failure. Corticosteroid therapy is a promising therapeutic candidate to suppress a cytokine storm that may manifest in these patients. The latest World Health Organization guidance recommends corticosteroids for severe/critical ill patients. However, most of the randomized trials reported so far did not include non-severe patients who did not require invasive or noninvasive ventilation. Thus, the usefulness and necessity of corticosteroids for COVID-19 remains controversial, especially for the patients who do not require invasive or noninvasive ventilation. Moreover, many factors remain unclear regarding the appropriate use of corticosteroids for COVID-19, such as initial dose, administration period, and timing of initiation. In this context, this multicenter, retrospective, propensity score–matched study was launched to evaluate the efficacy of systemic corticosteroid administration for hospitalized patients with COVID-19 ranging in the degree of severity from mild to critically-ill disease.

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Photo by Fusion Medical Animation on Unsplash

Photo by Fusion Medical Animation on Unsplash

Why is it important?

This study demonstrated the following 3 important clinical observations: (1) Corticosteroids did not lead to avoidance of tracheal intubation or lower mortality in patients with mild to severe COVID-19 who do not require invasive or noninvasive ventilation at baseline. (2) For the critically ill patients, corticosteroid therapy reduced not only the time to improvement in radiological findings, but also the duration of mechanical ventilation. (3) Methylprednisolone pulse/semi-pulse therapy significantly shortened the duration of mechanical ventilation compared with the usual dose regimen.

Perspectives