A commentary article concludes that, based on evidence from previous outbreaks of similar types of infection such as SARS, steroids provide little benefit to patients and could do more harm than good. They say that clinicians should still administer the treatment for conditions such as asthma and other inflammatory diseases.
Steroids are often used by doctors to reduce inflammation, which is present in the lungs of patients with novel coronavirus. Lung inflammation was observed during the SARS and MERS outbreaks, which were caused by coronaviruses.
However, steroids also impair the immune system's ability to fight viruses and other infections that often develop in patients with life-threatening illness. Experts say that, on balance, using the drugs could cause significant harm.
One retrospective study of critically-ill patients with MERS found that almost half of the people that received steroids needed additional treatments such as assistance in breathing, drugs to increase blood pressure, and a form of dialysis. Those given steroids were found to take longer to clear the virus from their bodies.
Other studies found that steroids caused harm in the SARS outbreak, with the virus still present in those who took the drugs up to three weeks after infection.
Dr J Kenneth Baillie, lead author of the commentary article and academic consultant in critical care medicine at University of Edinburgh, said: "During this current coronavirus outbreak clinicians are faced with some tough decisions on how to treat people who have been infected. After looking carefully at what evidence is available, we would advise that steroids should not be used for treatment of lung injury caused by this new virus. If steroids are used, it should be as part of a clinical trial so that we can find out if they are helping or harming patients."
Abstract
The 2019 novel coronavirus (2019-nCoV) outbreak is a major challenge for clinicians. The clinical course of patients remains to be fully characterised, little data are available that describe the disease pathogenesis, and no pharmacological therapies of proven efficacy yet exist. Corticosteroids were widely used during the outbreaks of severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV, and are being used in patients with 2019-nCoV in addition to other therapeutics. However, current interim guidance from WHO on clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected (released Jan 28, 2020) advises against the use of corticosteroids unless indicated for another reason. Understanding the evidence for harm or benefit from corticosteroids in 2019-nCoV is of immediate clinical importance. Here we discuss the clinical outcomes of corticosteroid use in coronavirus and similar outbreaks.
Authors
Clark D Russell, Jonathan E Millar, J Kenneth Baillie
[link url="https://www.ed.ac.uk/news/2020/steroids-could-do-more-harm-than-good-coronavirus"]University of Edinburgh material[/link]
[link url="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30317-2/fulltext"]The Lancet abstract[/link]