Contrasting evidence for corticosteroid treatment for coronavirus-induced cytokine storm

• Published in: Hong Kong medical journal = Xianggang yi xue za zhi 2020-06, Vol.26 (3), p.269-271
• Main Authors: Leung, K K Y, Hon, K L, Qian, S Y, Cheng, F W T
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones; Betacoronavirus; Coronavirus; Coronavirus Infections; Coronaviruses; COVID-19; Cytokine storm; Cytokines; Disease; Drug dosages; Epidemics; Epidemiology; Humans; Lung Injury; Mortality; Pandemics; Physicians; Pneumonia; Pneumonia, Viral; SARS-CoV-2; Severe acute respiratory syndrome; Steroids
• ISSN: 1024-2708; 2226-8707
• DOI: 10.12809/hkmj208517

In clinical settings, physicians tend to use corticosteroids only for treating critically ill patients. [...]selection bias and confounders in observational studies might contribute to any observed increased mortality in patient groups treated with corticosteroids. Adapted from cases reported by Russell et al1 with counter comments Similar to respiratory viral diseases such as the seasonal influenza, two categories of people seem susceptible to die from COVID-19: older adults, especially those with chronic disease or other co-morbidities, and seemingly healthy adults with exacerbated autoinflammatory syndrome termed the cytokine storm syndromes.3 4 5 On the contrary, children and infants seem to survive epidemics of coronavirus infections with very mild disease.6 We acknowledge the potential risks associated with high-dose corticosteroids in treating COVID-19 pneumonia, and agree that corticosteroid usage should be avoided if there are other efficacious anti-inflammatory immunomodulating medications against the cytokine storm, such as intravenous immunoglobulin, interleukin-1 inhibitors, interleukin-6 inhibitors, and Janus kinase inhibitors.4However, on the basis of recommendations by frontline Chinese physicians and local clinical experience during the severe acute respiratory syndrome epidemic, a short course of corticosteroids at low-to-moderate dose is probably justifiable for critically ill patients with hyperinflammation.7 8Chinese researchers are running a prospective randomised controlled trial to review the efficacy and safety of corticosteroids.9 Until further evidence becomes available, whether to use corticosteroids or not remains controversial. Karen KY Leung 1; KL Hon 1; SY Qian 2; Frankie WT Cheng 1 1 Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Hong Kong 2 Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, China