PMC:7324763 / 73499-75851 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7324763","sourcedb":"PMC","sourceid":"7324763","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7324763","text":"Corticosteroids\nCorticosteroids have played a key role in the treatment of auto-immune diseases over the past 70 years (251, 252). Whether endogenous or exogenous, corticosteroids decrease the number of circulating monocytes and lymphocytes and decrease synthesis of pro-inflammatory cytokines (IL-2, IL-6, TNF-α) (251). Their strong anti-inflammatory and immunosuppressive effects make them good candidates for rapidly suppressing inflammation during early auto-immune disease or viral infections. Corticosteroids have been shown to inhibit NK cells in ex vivo experiments (253, 254). While corticosteroids may delay clearance of infections, their major benefit lies in suppressing excessive innate immune responses, thus preventing lung damage and ARDS commonly present in severe viral infections (255–257). In fact, this was the main rationale for the widespread use of corticosteroids during MERS and SARS infections (255, 256). Specific to COVID-19, some groups have advocated for the use of low-dose corticosteroids in a specific subset of critically-ill patients with refractory ARDS, sepsis, or septic shock (Table 2) (257). There is one known ongoing randomized clinical trial examining the effect of the corticosteroid ciclesonide in adults with mild COVID-19 infections (NCT04330586). This trial is based on preclinical studies showing in vitro antiviral activity of ciclesonide against SARS-CoV-2.\nWhile there may be a benefit to using corticosteroids in a subset of critically-ill patients with refractory ARDS or sepsis (257), their routine use in COVID-19 is not recommended outside of clinical trials, based on expert opinion and WHO recommendations (258–260). Corticosteroids also cause a multitude of side effects, most notably diabetes mellitus, osteoporosis, and increased risk of infections (251). Controversially, a 2019 systematic review of over 6,500 influenza patients showed that corticosteroids actually led to increased mortality, length of ICU stay, and secondary infections (261). Additionally, one retrospective observational study examined the use of corticosteroids in 31 COVID-19 patients, and reported no significant association between corticosteroids and viral clearance time, hospital length of stay, or duration of symptoms (262). These studies highlight the need to be vigilant in our attempts to fight 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