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Choi: Is Longer Duration or Higher Dose of Steroid Use Effective in Critical COVID-19 Patients?: An Area of Uncertainty
Editorial
Infectious Diseases, Microbiology & Parasitology

Journal of Korean Medical Science 2022; 37(29): e242.

Published online: 20 July 2022

DOI: https://doi.org/10.3346/jkms.2022.37.e242

Is Longer Duration or Higher Dose of Steroid Use Effective in Critical COVID-19 Patients?: An Area of Uncertainty

Won Suk Choi

Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.

Address for Correspondence: Won Suk Choi, MD, PhD. Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Ansan Hospital 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Korea. cmcws@korea.ac.kr

Received 20 July 2022       Accepted 20 July 2022

© 2022 The Korean Academy of Medical Sciences.

The Korean Academy of Medical Sciences

https://creativecommons.org/licenses/by-nc/4.0/
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
In the early days of the COVID-19 pandemic, there was a controversy about the use of steroids. However, as the results of several clinical studies, including the RECOVERY trial,1 have been reported, steroid use for COVID-19 patients who require oxygen therapy is establishing itself as a standard treatment measure. Various guidelines for COVID-19 recommend the use of steroids for moderate to severe patients, and it is usually recommended to administer dexamethasone 6 mg for 10 days or until discharge.23 However, it has not been sufficiently evaluated whether steroid use beyond the generally recommended regimen is helpful in patients who continue to be in severe condition.
Oh et al.4 described how steroids are used in real clinical settings and the characteristics of patients who have been treated with longer duration or higher dose of steroids. According to the study results, among the steroid group, 17.5% of the patients received longer duration or higher dose of steroid. The patients were older, had a longer hospital stay, and were applied mechanical ventilator or extracorporeal membrane oxygenation more frequently compared to patients who received regular doses of steroid. This means that physicians attempted to improve the prognosis by increasing the dose or the duration of steroid in patients with severe or critical state. The results of this study can serve as resource for hints for steroid use in treating severe or critical COVID-19 patients.
However, we still do not know whether longer duration or higher dose of steroid will be helpful for the COVID-19 patients. Few studies have compared prognosis according to steroid dose. One study compared the use of 8 mg and 16 mg of dexamethasone for the treatment of COVID-19-related respiratory distress syndrome and found that there was no difference in ventilator-free days, but the higher dose group showed improved time required to be liberated from the mechanical ventilator.5 Studies on optimal duration of steroid use are more limited, in particular, for the patients with persistent severe conditions.
Recently, there have been attempts to use steroids in relation to post-COVID condition, and there are reports that steroid use has helped improve the condition of some patients. However, sufficient evidence has not yet been provided as to which patients and which steroid regimen will be helpful.
As various research results and experiences have been accumulated in the treatment of COVID-19 patients, standard treatment strategies are gradually being established, but there are still many areas of uncertainty. The optimal steroid use for patients with severe or critical condition is one of these areas of uncertainty. It is hoped that related research will continue to be conducted in the future to find the best way to improve the prognosis of COVID-19 patients.

Notes

Disclosure: The author has no potential conflicts of interest to disclosure.

References

1. RECOVERY Collaborative Group. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021; 384(8):693–704. PMID: 32678530.
crossref
2. National Institutes of Health. Coronavirus disease 2019 (COVID-19) treatment guidelines. Updated 2022. Accessed July 18, 2022.
3. Infectious diseases society of America guidelines on the treatment and management of patients with COVID-19. Updated 2022. Accessed July 18, 2022. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management .
4. Oh SM, Ham SY, Suh HJ, Lee E, Park SW. Clinical characteristics of COVID-19: use of steroids in mostly unvaccinated COVID-19 patients before the omicron variant. J Korean Med Sci. 2022; 37(29):e228.
crossref
5. Maskin LP, Bonelli I, Olarte GL, Palizas F Jr, Velo AE, Lurbet MF, et al. High- versus low-dose dexamethasone for the treatment of COVID-19-related acute respiratory distress syndrome: a multicenter, randomized open-label clinical trial. J Intensive Care Med. 2022; 37(4):491–499. PMID: 34898320.
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