Coronavirus Disease 2019 Treatment: A Review of Early and Emerging Options

McCreary, Erin K; Pogue, Jason M

Similar to other severe respiratory tract infections, there is significant interest and controversy surrounding the role of corticosteroids for the management of severe pneumonia due to coronaviruses. The potential benefit of these agents to blunt the inflammatory cascade seen in severe disease needs to be carefully weighed against the concerns for secondary infections, adverse events, and other complications of corticosteroid therapy. The data assessing the role of corticosteroids as adjunctive care for severe coronavirus (SARS-CoV-1, MERS-CoV, and SARS-CoV-2) pneumonia are difficult to interpret. Given the retrospective observational nature of these analyses, there is significant confounding by indication that is difficult to control or correct for in addition to limited sample sizes. Patients who receive corticosteroids have a higher severity of illness, are more likely to require invasive interventions, and are more likely to be receiving intensive care. In addition, there is significant heterogeneity with regard to timing of corticosteroid initiation, which can significantly impact disease progression and likelihood of response. All of these features lead to patients who receive steroids being at increased risk for poor outcomes. In addition, there is great variation in agent and dosage used, which can impact both safety and efficacy. Therefore, clinicians making any therapeutic decisions based on the literature for corticosteroids need to keep these considerations in mind.