Answer Questions About Use of Steroids for COVID-19

Posted October 12, 2020: Article in Progress. We’re releasing this article ahead of our November 2020 issue to quickly provide information to our readers. The information contained in this version is based on the best evidence available to us as of the date of posting. The final version may include revised recommendations.

You’ll hear more about optimizing corticosteroids for COVID-19.

We know steroids can decrease mortality in COVID-19 patients requiring supplemental oxygen...based on one open-label trial.

Now a meta-analysis of 7 randomized trials is helping to confirm this benefit.

Consider these strategies when using steroids for COVID-19.

Continue to use steroids in hospitalized patients requiring supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).

Don’t give steroids to patients NOT on oxygen. They don’t seem to help these patients...and there’s a chance they may be harmful.

But keep patients on home oral or inhaled steroids used for chronic conditions (asthma, etc)...even for COVID-19 patients not on oxygen. In this case, benefit seems to outweigh risk.

Don’t rely on symptom onset when determining whether to use steroids. Some data suggest steroids are most helpful when started 7 days AFTER symptoms begin...but other evidence doesn’t confirm this.

Lean toward dexamethasone over hydrocortisone. Dexamethasone has more evidence. Plus it has the advantage of once-daily dosing...compared to up to 4 times/day for hydrocortisone.

Feel comfortable sticking with dexamethasone 6 mg/day...despite higher doses of 20 mg/day used in some studies.

There’s no proof higher doses work better. Also adverse effects, such as hyperglycemia, are dose-related.

If needed, consider methylprednisolone or prednisone...experts believe corticosteroid benefits are likely a class effect.

Continue steroids for 7 to 10 days...or until discharge if that’s sooner.

See our chart, Treatments of Interest for COVID-19, for other potential interventions.

References

  1. JAMA. 2020 Sep 2;324(13):1-13
  2. N Engl J Med. 2020 Jul 17; doi:10.1056/NEJMoa2021436
  3. https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1
  4. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management