| Id |
Subject |
Object |
Predicate |
Lexical cue |
| T443 |
0-15 |
Sentence |
denotes |
Corticosteroids |
| T444 |
16-130 |
Sentence |
denotes |
Corticosteroids have played a key role in the treatment of auto-immune diseases over the past 70 years (251, 252). |
| T445 |
131-320 |
Sentence |
denotes |
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). |
| T446 |
321-498 |
Sentence |
denotes |
Their strong anti-inflammatory and immunosuppressive effects make them good candidates for rapidly suppressing inflammation during early auto-immune disease or viral infections. |
| T447 |
499-585 |
Sentence |
denotes |
Corticosteroids have been shown to inhibit NK cells in ex vivo experiments (253, 254). |
| T448 |
586-809 |
Sentence |
denotes |
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). |
| T449 |
810-932 |
Sentence |
denotes |
In fact, this was the main rationale for the widespread use of corticosteroids during MERS and SARS infections (255, 256). |
| T450 |
933-1132 |
Sentence |
denotes |
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). |
| T451 |
1133-1295 |
Sentence |
denotes |
There is one known ongoing randomized clinical trial examining the effect of the corticosteroid ciclesonide in adults with mild COVID-19 infections (NCT04330586). |
| T452 |
1296-1409 |
Sentence |
denotes |
This trial is based on preclinical studies showing in vitro antiviral activity of ciclesonide against SARS-CoV-2. |
| T453 |
1410-1676 |
Sentence |
denotes |
While 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). |
| T454 |
1677-1818 |
Sentence |
denotes |
Corticosteroids also cause a multitude of side effects, most notably diabetes mellitus, osteoporosis, and increased risk of infections (251). |
| T455 |
1819-2010 |
Sentence |
denotes |
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). |
| T456 |
2011-2269 |
Sentence |
denotes |
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). |
| T457 |
2270-2352 |
Sentence |
denotes |
These studies highlight the need to be vigilant in our attempts to fight COVID-19. |
