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Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints
Prolonged, low-dose glucocorticoids (GCs) have shown the highest efficacy among pharmacological and non-pharmacological treatments for COVID-19. Despite the World Health Organization’s recommendation against their use at the beginning of the pandemic, GCs at a dose equivalent to dexamethasone 6 mg/d...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10385094/ https://www.ncbi.nlm.nih.gov/pubmed/37513836 http://dx.doi.org/10.3390/ph16070924 |
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author | Salton, Francesco Confalonieri, Paola Meduri, Gianfranco Umberto Mondini, Lucrezia Trotta, Liliana Barbieri, Mariangela Bozzi, Chiara Torregiani, Chiara Lerda, Selene Bellan, Mattia Confalonieri, Marco Ruaro, Barbara Tavano, Stefano Pozzan, Riccardo |
author_facet | Salton, Francesco Confalonieri, Paola Meduri, Gianfranco Umberto Mondini, Lucrezia Trotta, Liliana Barbieri, Mariangela Bozzi, Chiara Torregiani, Chiara Lerda, Selene Bellan, Mattia Confalonieri, Marco Ruaro, Barbara Tavano, Stefano Pozzan, Riccardo |
author_sort | Salton, Francesco |
collection | PubMed |
description | Prolonged, low-dose glucocorticoids (GCs) have shown the highest efficacy among pharmacological and non-pharmacological treatments for COVID-19. Despite the World Health Organization’s recommendation against their use at the beginning of the pandemic, GCs at a dose equivalent to dexamethasone 6 mg/day for 10 days are now indicated in all COVID-19 cases who require respiratory support. However, the efficacy of the intervention depends on the timing of initiation, the dose, and other individual factors. Indeed, patients treated with similar GC protocols often experience different outcomes, which do not always correlate with the presence of comorbidities or with the severity of respiratory involvement at baseline. This prompted us to critically review the literature on the rationale, pharmacological principles, and clinical evidence that should guide GC treatment. Based on these data, the best treatment protocol probably involves an initial bolus dose to saturate the glucocorticoid receptors, followed by a continuous infusion to maintain constant plasma levels, and eventually a slow tapering to interruption. Methylprednisolone has shown the highest efficacy among different GC molecules, most likely thanks to its higher ability to penetrate the lung. Decreased tissue sensitivity to glucocorticoids is thought to be the main mechanism accounting for the lower response to the treatment in some individuals. We do not have a readily available test to identify GC resistance; therefore, to address inter-individual variability, future research should aim at investigating clinical, physiological, and laboratory markers to guide a personalized GC treatment approach. |
format | Online Article Text |
id | pubmed-10385094 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-103850942023-07-30 Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints Salton, Francesco Confalonieri, Paola Meduri, Gianfranco Umberto Mondini, Lucrezia Trotta, Liliana Barbieri, Mariangela Bozzi, Chiara Torregiani, Chiara Lerda, Selene Bellan, Mattia Confalonieri, Marco Ruaro, Barbara Tavano, Stefano Pozzan, Riccardo Pharmaceuticals (Basel) Review Prolonged, low-dose glucocorticoids (GCs) have shown the highest efficacy among pharmacological and non-pharmacological treatments for COVID-19. Despite the World Health Organization’s recommendation against their use at the beginning of the pandemic, GCs at a dose equivalent to dexamethasone 6 mg/day for 10 days are now indicated in all COVID-19 cases who require respiratory support. However, the efficacy of the intervention depends on the timing of initiation, the dose, and other individual factors. Indeed, patients treated with similar GC protocols often experience different outcomes, which do not always correlate with the presence of comorbidities or with the severity of respiratory involvement at baseline. This prompted us to critically review the literature on the rationale, pharmacological principles, and clinical evidence that should guide GC treatment. Based on these data, the best treatment protocol probably involves an initial bolus dose to saturate the glucocorticoid receptors, followed by a continuous infusion to maintain constant plasma levels, and eventually a slow tapering to interruption. Methylprednisolone has shown the highest efficacy among different GC molecules, most likely thanks to its higher ability to penetrate the lung. Decreased tissue sensitivity to glucocorticoids is thought to be the main mechanism accounting for the lower response to the treatment in some individuals. We do not have a readily available test to identify GC resistance; therefore, to address inter-individual variability, future research should aim at investigating clinical, physiological, and laboratory markers to guide a personalized GC treatment approach. MDPI 2023-06-25 /pmc/articles/PMC10385094/ /pubmed/37513836 http://dx.doi.org/10.3390/ph16070924 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Salton, Francesco Confalonieri, Paola Meduri, Gianfranco Umberto Mondini, Lucrezia Trotta, Liliana Barbieri, Mariangela Bozzi, Chiara Torregiani, Chiara Lerda, Selene Bellan, Mattia Confalonieri, Marco Ruaro, Barbara Tavano, Stefano Pozzan, Riccardo Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints |
title | Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints |
title_full | Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints |
title_fullStr | Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints |
title_full_unstemmed | Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints |
title_short | Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter—A Critical Review and Viewpoints |
title_sort | theory and practice of glucocorticoids in covid-19: getting to the heart of the matter—a critical review and viewpoints |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10385094/ https://www.ncbi.nlm.nih.gov/pubmed/37513836 http://dx.doi.org/10.3390/ph16070924 |
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