ACADEMIA Letters
A STUDY ON STEROID THERAPY FOR COVID-19
PATIENTS (A short communication)
K. Shailaja Ganesh, M Pharm., Ph D., Associate Professor Department of Pharmacy
Practice, C. L. Baid Metha College of Pharmacy, The Tamilnadu Dr. MGR Medical
University Tamil Nadu, India.
Deepika Ganesh, Pharm D student, C. L. Baid Metha College of Pharmacy, The
Tamilnadu Dr. MGR Medical University Tamil Nadu, India.
Dorathi Ria Monisha A, Pharm D student, C. L. Baid Metha College of Pharmacy,
The Tamilnadu Dr. MGR Medical University Tamil Nadu, India.
Jaya Kumar V, Pharm D student, C. L. Baid Metha College of Pharmacy, The
Tamilnadu Dr. MGR Medical University Tamil Nadu, India.
Pavithra A, Pharm D student, C. L. Baid Metha College of Pharmacy, The
Tamilnadu Dr. MGR Medical University Tamil Nadu, India.
Vishnu T, Pharm D student, C. L. Baid Metha College of Pharmacy, The Tamilnadu
Dr. MGR Medical University Tamil Nadu, India.
INTRODUCTION
COVID–19 swooped in as an unexpected force and made the world dive into a global lockdown. It brought about a situation that no country could ever foresee or be equipped to handle.
COVID–19 is caused by the new coronavirus, SARS-CoV-2, which seemed to have originated
by December 2019. Some people infected with the coronavirus experienced mild symptoms
like cold, cough, fever, headache, loss of taste and smell while some cases of COVID–19 led
to severe symptoms like respiratory failure [1]. Patients with severe COVID–19 tend to develop a systemic inflammatory response which can lead to lung injury and multisystem organ
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
1
dysfunction. The potent anti-inflammatory effects of corticosteroids are thought to prevent or
mitigate these severe effects [2].
Although the majority of the patients undergo recovery, some patients’ conditions worsen
and caused severe pneumonia. After an incubation period of 4 days, Adult Respiratory Distress Syndrome (ARDS) usually develops during the second week in COVID–19 patients.
This is a result of increased viral replication and an eruptive immune response from the host
cell. With uncontrolled viral replication occurs angiotensin-converting-enzyme 2 (ACE2)
directed cytotoxicity, which triggers an immune response in the host cell and causes hyperinflammation. The infected cells further lead to the release of an enormous number of cytokines
which is called the ‘cytokine storm’ [3].
Although corticosteroids cause immune suppression by impairing innate immunity, longterm maintenance doses of steroids have shown to have no increase in the severity of pneumonia in COVID-19 patients. WHO and CDC advise against the use of steroids due to the fear
of worsening viral propagation. The Multinational Surviving Sepsis Guideline in COVID–19
recommends giving steroids in patients with severe COVID–19 on mechanical ventilation with
ARDS. This guideline also advises against the use of corticosteroids in non-ARDS COVID19 patients [2,3]. Therefore, steroids are recommended for severe COVID–19 patients on
mechanical ventilation with ARDS [1,2].
CORTICOSTEROIDS
Corticosteroids have a wide range of uses. Their major clinical use arises from their potent
anti-inflammatory and immune-modulating properties. The anti-inflammatory properties of
steroids have been attributed to their inhibitory effects on the action of phospholipase A2, an
enzyme critical to the production of inflammatory compounds [4].
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
2
Source: https://doi.org/10.1038/s41591-020-0968-3
The use of corticosteroids for SARS-CoV-2 is often met with objections due to their immunosuppressive effects. But with the progression of the pandemic at a rapid pace, the adjunctive use of corticosteroids with other drugs was found to have a potential role in the management of COVID-19 [5].
Most of the adverse outcomes of coronavirus disease are associated with severe inflammation, lung injury secondary to ARDS, and thus, diffuse alveolar damage. Therefore, to control
the immune-mediated damage of the lung tissue, corticosteroid drugs have been given in severe cases of coronavirus such as MERS (Middle East Respiratory Syndrome), SARS severe
acute respiratory syndrome, and SARS-CoV-2 [5,6]. Due to their quick anti-inflammatory
and immunosuppressive impact, corticosteroids medications are broadly used to treat hyperinflammatory conditions, including the previous coronavirus diseases such as MERS and
SARS. The primary reason for the use of glucocorticoids is that they might be beneficial
in preventing the damage of pulmonary structures in the case of SARS-CoV-2 by inhibiting
cytokine production [6].
Corticosteroids that are commonly employed for the management of COVID-19 are:
• Dexamethasone
• Methylprednisolone
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
3
DEXAMETHASONE
Dexamethasone is a steroid compound, belonging to the corticosteroid class glucocorticoids.
It is used in the treatment of various conditions including chronic obstructive lung disease,
severe allergies, brain swelling, and they are also used as alongside antibiotics in tuberculosis
[6,7].
One of the main roles of glucocorticoids is that they cause immunosuppression and are
anti-inflammatory in nature. They suppress the adaptive immune response and cause modulation of several biological functions in immune cells and in different organs and tissues in
the Human body [6,8].
Dexamethasone reduced the 28- day mortality by 35% in patients receiving invasive mechanical ventilation. They received standard care plus dexamethasone 20 mg IV once daily
for 5 days and then dexamethasone 10 mg daily for 10 days [11]. It had no benefit on the
outcomes of patients who had mild symptoms, so it was found suitable only for patients who
were in the hospital under mechanical ventilation. Dexamethasone prevented the worsening
of ventilator parameters and subsequent ventilation. It also reduced the duration of hospital
stays [6].
METHYLPREDNISOLONE
Methylprednisolone is a systemic synthetic corticosteroid. The clinical use of methylprednisolone is mainly due to its anti-inflammatory and immunosuppressive activity in the human
body [9].
It is a white, odorless, crystalline powder that binds to and activates specific nuclear receptors, resulting in altered gene expression and inhibition of proinflammatory cytokine production. Methylprednisolone is a prednisolone derivative glucocorticoid with higher potency
than prednisolone [10].
Early administration of methylprednisolone was associated with reduced rates of mortality
and decreased the need for mechanical ventilation by 37% [9]. The total daily dose equivalent
to dexamethasone 6 mg oral or IV dose of 32 mg administered once daily or in two divided
doses daily [11].
With its increased treatment potential one side effect to monitor for is steroid-induced
hyperglycemia. Glucocorticoids have been shown to increase insulin resistance and increase
glucose levels up to 68% compared to the baseline in about 46% of the patients. It not only
exacerbates hyperglycemia in patients with known Diabetes Mellitus but can also cause diabetes mellitus in patients without any prior history of hyperglycemia before the initiation of
glucocorticoids [18].
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
4
OTHER TREATMENT STRATEGIES
Other treatment strategies that were found to be significant in improving the treatment outcome
are:
1. Anti-viral agents like Remdesivir: It is a broad-spectrum antiviral drug that is approved
as one of the possible direct anti-viral medications against SARS-CoV-2. Studies show
that 68% of severe COVID-19 patients who were treated with Remdesivir showed clinical improvement [15,16].
2. Tocilizumab: It is a recombinant humanized monoclonal antibody that targets both
membrane-bound and soluble forms of IL-6 receptors. It has been shown to have a significant clinical improvement in the respiratory conditions, improved peripheral oxygen
saturation in 75% of the patients [15,17].
3. Supportive treatments: Supportive treatments include antipyretics for fever and pain,
dehydration, and vitamin supplements like vitamin C [15,16].
MIS-C AND COVID-19
Multisystem inflammatory syndrome in children (MIS-C) is an inflammatory condition where
different organs can get inflamed including the heart, lungs, kidneys, brain, and gastrointestinal organs [12]. It occurs about after 4 weeks with coronavirus infection. It is a rare complication of COVID-19 whose symptoms often overlap with other conditions like toxic shock
syndrome and Kawasaki disease. MIS-C is triggered by the SARS-CoV-2 virus. It can occur
in children who do not present with the common symptoms of COVID-19 like fever, sore
throat, or cough. They possess antibodies to the virus indicating that they have been infected
previously with coronavirus. Immunoglobulins and steroids are used to reduce inflammation
and protect the organs from any lasting damage [13].
CONCLUSION
Corticosteroids have been a mainstay of treatment in this pandemic. It has been shown to
improve severe cases of COVID-19, but it does not seem to show any improvement in mild
cases of the disease. They are not deemed to be the cure for this pandemic, but it is a treatment
option that is adapted and has shown some significant positive outcomes. As the side effects
of the use of corticosteroids are a main source of concern, their use is advised to be limited
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
5
to severe cases of COVID-19. Though we have not completely eradicated the coronavirus,
further studies are required to assess the safety and efficacy of corticosteroid use in COVID19 patients.
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
6
REFERENCES
[1] COVID-19 Information and updates. accessed (2021, May 19).
[2] Manuel Ramos Casals, Pilar Brito-Zeron, Xavier Mariette (2021). Systemic and organspecific immune-related manifestations of COVID-19. Nature reviews rheumatology, 17,
315-332.
[3] Awadhesh Kumar Singh, Sujoy Majumdar, Ritu Singh, Anoop Misra (2020). Role of
corticosteroid in the management of COVID 19: A systematic review and a clinician’s
perspective. Diabetes Metab Syndr., 14(5), 971-978.
[4] William Ericson Neilson, Alan David Kaye. (2014). Steroids. Pharmacology, Complications, and Practice Delivery Issues. Ochsner J, 14(2), 203-207.
[5] P. Mattos-Silva et al (2020). Pros and Cons of corticosteroid therapy for COVID-19
patients. Respiratory Physiology & Neurobiology, 280, 103492.
[6] Mukhtar H Ahmed, Arez Hassan (2020). Dexamethasone for the treatment of coronavirus
disease (COVID 19): a Review. SN Compr Clin Med., 31,1-10.
[7] M. Emamai Ardestani et al., (2017). Methylprednisolone vs dexamethasone in management of COPD exacerbation; a randomized clinical trial. Emergency, 5(1), e35.
[8] The Recovery Collaborative Group (2020). Dexamethasone in Hospitalized Patients with
Covid-19- Preliminary report. N Engl J Med., doi:10.1056/NEJMoa2021436.
[9] Papamanoli et al (2020). High-dose methylprednisolone in non-intubated patients with
severe COVID-19 pneumonia. Eur J Clin Invest, e13458.
[10] Dennis M Williams (2018). Clinical pharmacology of corticosteroids. Respiratory Care,
8(63), 655-667.
[11] COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Accessed [December 16, 2021].
[12] For Parents: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with
COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/mis/misc.html.
[13] Anna Christina Sick-Samuels. (updates 2021) MIS-C and COVID-19: Uncommon but
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
7
Serious Inflammatory Syndrome in Kids and Teens.
[14] Gupta, A., Madhavan, M.V., Sehgal, K. et al. (2020). Extrapulmonary manifestations
of COVID-19. Nat Med 26, 1017–1032. https://doi.org/10.1038/s41591-020-0968-3.
[15] Tao-Hsin Tung, Xiao-Qing Lin, Yan Chen, Mei-Xian Zhang, Jian-Sheng Zhu. (2022)
Willingness to receive a booster dose of inactivated coronavirus disease 2019 vaccine in
Taizhou, China. Expert Review of Vaccines, 21, 2, 261-267.
[16] Rahman, S., Montero, M., Rowe, K., Kirton, R., & Kunik, F., Jr (2021). Epidemiology,
pathogenesis, clinical presentations, diagnosis and treatment of COVID-19: a review of
current evidence. Expert review of clinical pharmacology, 14(5), 601–621.
[17] Xu X, Han M, Li T, Sun W, Wang D, Fu B, Zhou Y, Zheng X, Yang Y, Li X, Zhang X,
Pan A, Wei H. (2020). Effective treatment of severe COVID-19 patients with tocilizumab.
Proc Natl Acad Sci U S A. 117(20),10970-10975. doi: 10.1073/pnas.2005615117. Epub
2020 Apr 29. PMID: 32350134; PMCID: PMC7245089.
[18] Tamez-Pérez, H. E., Quintanilla-Flores, D. L., Rodríguez-Gutiérrez, R., GonzálezGonzález, J. G., & Tamez-Peña, A. L. (2015). Steroid hyperglycemia: Prevalence, early
detection and therapeutic recommendations: A narrative review. World journal of diabetes, 6(8), 1073–1081. https://doi.org/10.4239/wjd.v6.i8.1073.
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
8
ACADEMIA Letters
A STUDY ON STEROID THERAPY FOR COVID-19
PATIENTS (A short communication)
K. Shailaja Ganesh, M Pharm., Ph D., Associate Professor Department of Pharmacy
Practice, C. L. Baid Metha College of Pharmacy, The Tamilnadu Dr. MGR Medical
University Tamil Nadu, India.
Deepika Ganesh, Pharm D student, C. L. Baid Metha College of Pharmacy, The
Tamilnadu Dr. MGR Medical University Tamil Nadu, India.
Dorathi Ria Monisha A, Pharm D student, C. L. Baid Metha College of Pharmacy,
The Tamilnadu Dr. MGR Medical University Tamil Nadu, India.
Jaya Kumar V, Pharm D student, C. L. Baid Metha College of Pharmacy, The
Tamilnadu Dr. MGR Medical University Tamil Nadu, India.
Pavithra A, Pharm D student, C. L. Baid Metha College of Pharmacy, The
Tamilnadu Dr. MGR Medical University Tamil Nadu, India.
Vishnu T, Pharm D student, C. L. Baid Metha College of Pharmacy, The Tamilnadu
Dr. MGR Medical University Tamil Nadu, India.
INTRODUCTION
COVID–19 swooped in as an unexpected force and made the world dive into a global lockdown. It brought about a situation that no country could ever foresee or be equipped to handle.
COVID–19 is caused by the new coronavirus, SARS-CoV-2, which seemed to have originated
by December 2019. Some people infected with the coronavirus experienced mild symptoms
like cold, cough, fever, headache, loss of taste and smell while some cases of COVID–19 led
to severe symptoms like respiratory failure [1]. Patients with severe COVID–19 tend to develop a systemic inflammatory response which can lead to lung injury and multisystem organ
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
1
dysfunction. The potent anti-inflammatory effects of corticosteroids are thought to prevent or
mitigate these severe effects [2].
Although the majority of the patients undergo recovery, some patients’ conditions worsen
and caused severe pneumonia. After an incubation period of 4 days, Adult Respiratory Distress Syndrome (ARDS) usually develops during the second week in COVID–19 patients.
This is a result of increased viral replication and an eruptive immune response from the host
cell. With uncontrolled viral replication occurs angiotensin-converting-enzyme 2 (ACE2)
directed cytotoxicity, which triggers an immune response in the host cell and causes hyperinflammation. The infected cells further lead to the release of an enormous number of cytokines
which is called the ‘cytokine storm’ [3].
Although corticosteroids cause immune suppression by impairing innate immunity, longterm maintenance doses of steroids have shown to have no increase in the severity of pneumonia in COVID-19 patients. WHO and CDC advise against the use of steroids due to the fear
of worsening viral propagation. The Multinational Surviving Sepsis Guideline in COVID–19
recommends giving steroids in patients with severe COVID–19 on mechanical ventilation with
ARDS. This guideline also advises against the use of corticosteroids in non-ARDS COVID19 patients [2,3]. Therefore, steroids are recommended for severe COVID–19 patients on
mechanical ventilation with ARDS [1,2].
CORTICOSTEROIDS
Corticosteroids have a wide range of uses. Their major clinical use arises from their potent
anti-inflammatory and immune-modulating properties. The anti-inflammatory properties of
steroids have been attributed to their inhibitory effects on the action of phospholipase A2, an
enzyme critical to the production of inflammatory compounds [4].
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
2
Source: https://doi.org/10.1038/s41591-020-0968-3
The use of corticosteroids for SARS-CoV-2 is often met with objections due to their immunosuppressive effects. But with the progression of the pandemic at a rapid pace, the adjunctive use of corticosteroids with other drugs was found to have a potential role in the management of COVID-19 [5].
Most of the adverse outcomes of coronavirus disease are associated with severe inflammation, lung injury secondary to ARDS, and thus, diffuse alveolar damage. Therefore, to control
the immune-mediated damage of the lung tissue, corticosteroid drugs have been given in severe cases of coronavirus such as MERS (Middle East Respiratory Syndrome), SARS severe
acute respiratory syndrome, and SARS-CoV-2 [5,6]. Due to their quick anti-inflammatory
and immunosuppressive impact, corticosteroids medications are broadly used to treat hyperinflammatory conditions, including the previous coronavirus diseases such as MERS and
SARS. The primary reason for the use of glucocorticoids is that they might be beneficial
in preventing the damage of pulmonary structures in the case of SARS-CoV-2 by inhibiting
cytokine production [6].
Corticosteroids that are commonly employed for the management of COVID-19 are:
• Dexamethasone
• Methylprednisolone
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
3
DEXAMETHASONE
Dexamethasone is a steroid compound, belonging to the corticosteroid class glucocorticoids.
It is used in the treatment of various conditions including chronic obstructive lung disease,
severe allergies, brain swelling, and they are also used as alongside antibiotics in tuberculosis
[6,7].
One of the main roles of glucocorticoids is that they cause immunosuppression and are
anti-inflammatory in nature. They suppress the adaptive immune response and cause modulation of several biological functions in immune cells and in different organs and tissues in
the Human body [6,8].
Dexamethasone reduced the 28- day mortality by 35% in patients receiving invasive mechanical ventilation. They received standard care plus dexamethasone 20 mg IV once daily
for 5 days and then dexamethasone 10 mg daily for 10 days [11]. It had no benefit on the
outcomes of patients who had mild symptoms, so it was found suitable only for patients who
were in the hospital under mechanical ventilation. Dexamethasone prevented the worsening
of ventilator parameters and subsequent ventilation. It also reduced the duration of hospital
stays [6].
METHYLPREDNISOLONE
Methylprednisolone is a systemic synthetic corticosteroid. The clinical use of methylprednisolone is mainly due to its anti-inflammatory and immunosuppressive activity in the human
body [9].
It is a white, odorless, crystalline powder that binds to and activates specific nuclear receptors, resulting in altered gene expression and inhibition of proinflammatory cytokine production. Methylprednisolone is a prednisolone derivative glucocorticoid with higher potency
than prednisolone [10].
Early administration of methylprednisolone was associated with reduced rates of mortality
and decreased the need for mechanical ventilation by 37% [9]. The total daily dose equivalent
to dexamethasone 6 mg oral or IV dose of 32 mg administered once daily or in two divided
doses daily [11].
With its increased treatment potential one side effect to monitor for is steroid-induced
hyperglycemia. Glucocorticoids have been shown to increase insulin resistance and increase
glucose levels up to 68% compared to the baseline in about 46% of the patients. It not only
exacerbates hyperglycemia in patients with known Diabetes Mellitus but can also cause diabetes mellitus in patients without any prior history of hyperglycemia before the initiation of
glucocorticoids [18].
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
4
OTHER TREATMENT STRATEGIES
Other treatment strategies that were found to be significant in improving the treatment outcome
are:
1. Anti-viral agents like Remdesivir: It is a broad-spectrum antiviral drug that is approved
as one of the possible direct anti-viral medications against SARS-CoV-2. Studies show
that 68% of severe COVID-19 patients who were treated with Remdesivir showed clinical improvement [15,16].
2. Tocilizumab: It is a recombinant humanized monoclonal antibody that targets both
membrane-bound and soluble forms of IL-6 receptors. It has been shown to have a significant clinical improvement in the respiratory conditions, improved peripheral oxygen
saturation in 75% of the patients [15,17].
3. Supportive treatments: Supportive treatments include antipyretics for fever and pain,
dehydration, and vitamin supplements like vitamin C [15,16].
MIS-C AND COVID-19
Multisystem inflammatory syndrome in children (MIS-C) is an inflammatory condition where
different organs can get inflamed including the heart, lungs, kidneys, brain, and gastrointestinal organs [12]. It occurs about after 4 weeks with coronavirus infection. It is a rare complication of COVID-19 whose symptoms often overlap with other conditions like toxic shock
syndrome and Kawasaki disease. MIS-C is triggered by the SARS-CoV-2 virus. It can occur
in children who do not present with the common symptoms of COVID-19 like fever, sore
throat, or cough. They possess antibodies to the virus indicating that they have been infected
previously with coronavirus. Immunoglobulins and steroids are used to reduce inflammation
and protect the organs from any lasting damage [13].
CONCLUSION
Corticosteroids have been a mainstay of treatment in this pandemic. It has been shown to
improve severe cases of COVID-19, but it does not seem to show any improvement in mild
cases of the disease. They are not deemed to be the cure for this pandemic, but it is a treatment
option that is adapted and has shown some significant positive outcomes. As the side effects
of the use of corticosteroids are a main source of concern, their use is advised to be limited
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
5
to severe cases of COVID-19. Though we have not completely eradicated the coronavirus,
further studies are required to assess the safety and efficacy of corticosteroid use in COVID19 patients.
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
6
REFERENCES
[1] COVID-19 Information and updates. accessed (2021, May 19).
[2] Manuel Ramos Casals, Pilar Brito-Zeron, Xavier Mariette (2021). Systemic and organspecific immune-related manifestations of COVID-19. Nature reviews rheumatology, 17,
315-332.
[3] Awadhesh Kumar Singh, Sujoy Majumdar, Ritu Singh, Anoop Misra (2020). Role of
corticosteroid in the management of COVID 19: A systematic review and a clinician’s
perspective. Diabetes Metab Syndr., 14(5), 971-978.
[4] William Ericson Neilson, Alan David Kaye. (2014). Steroids. Pharmacology, Complications, and Practice Delivery Issues. Ochsner J, 14(2), 203-207.
[5] P. Mattos-Silva et al (2020). Pros and Cons of corticosteroid therapy for COVID-19
patients. Respiratory Physiology & Neurobiology, 280, 103492.
[6] Mukhtar H Ahmed, Arez Hassan (2020). Dexamethasone for the treatment of coronavirus
disease (COVID 19): a Review. SN Compr Clin Med., 31,1-10.
[7] M. Emamai Ardestani et al., (2017). Methylprednisolone vs dexamethasone in management of COPD exacerbation; a randomized clinical trial. Emergency, 5(1), e35.
[8] The Recovery Collaborative Group (2020). Dexamethasone in Hospitalized Patients with
Covid-19- Preliminary report. N Engl J Med., doi:10.1056/NEJMoa2021436.
[9] Papamanoli et al (2020). High-dose methylprednisolone in non-intubated patients with
severe COVID-19 pneumonia. Eur J Clin Invest, e13458.
[10] Dennis M Williams (2018). Clinical pharmacology of corticosteroids. Respiratory Care,
8(63), 655-667.
[11] COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Accessed [December 16, 2021].
[12] For Parents: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with
COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/mis/misc.html.
[13] Anna Christina Sick-Samuels. (updates 2021) MIS-C and COVID-19: Uncommon but
Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
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Academia Letters, February 2022
©2022 by the authors — Open Access — Distributed under CC BY 4.0
Corresponding Author: K. Shailaja Ganesh, shailajampharm@gmail.com
Citation: Ganesh, K.S., Ganesh, D., A, D.R.M., V, J.K., A, P., T, V. (2022). A STUDY ON STEROID
THERAPY FOR COVID-19 PATIENTS (A short communication). Academia Letters, Article 4826.
https://doi.org/10.20935/AL4826.
8
k.shailaja ganesh