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Last Updated: November 3, 2020. Patients with severe COVID-19 can develop a systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction. It has been proposed that the potent anti-inflammatory effects of corticosteroids might prevent or mitigate these deleterious effects. The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial, a multicenter, randomized, open-label trial in hospitalized patients with COVID-19, showed that the mortality from COVID-19 was lower among patients who were randomized to receive dexamethasone than among those who received the standard of care. The safety and efficacy of combination therapy of corticosteroids and an antiviral agent targeting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for the treatment of COVID-19 have not been rigorously studied in clinical trials. However, there are theoretical reasons that such combination therapy may be beneficial in patients with severe disease, trenaject 100 mg injectable steroids trenbolone acetate. See Therapeutic Management of Patients with COVID-19 for the Panel’s recommendations on use of dexamethasone with or without remdesivir in certain hospitalized patients. Rationale for Use of Corticosteroids in Patients With COVID-19. Both beneficial and deleterious clinical outcomes have been reported with use of corticosteroids (mostly prednisone or methylprednisolone) in patients with other pulmonary infections. In patients with Pneumocystis jirovecii pneumonia and hypoxia, prednisone therapy reduced the risk of death; 2 however, in outbreaks of other novel coronavirus infections (i. Corticosteroids have been studied in critically ill patients with acute respiratory distress syndrome (ARDS) with conflicting results. Recommendations on the use of corticosteroids for COVID-19 are largely based on data from the RECOVERY trial, a large, multicenter, randomized, open-label trial performed in the United Kingdom. This trial compared hospitalized patients who received up to 10 days of dexamethasone to those who received the standard of care. Mortality at 28 days was lower among patients who were randomized to receive dexamethasone than among those who received the standard of care. No benefit of dexamethasone was seen in patients who did not require supplemental oxygen at enrollment. Details of the RECOVERY trial are discussed in Table 4a. Corticosteroids used in various formulations and doses and for varying durations in patients with COVID-19 were also studied in several smaller randomized controlled trials. Given that the sample size of many these trials was insufficient to assess efficacy, evidence to support the use of methylprednisolone and hydrocortisone for the treatment of COVID-19 is not as robust as that demonstrated for dexamethasone in the RECOVERY trial. Data from some of these studies can be found in Table 4a. Corticosteroids Other Than Dexamethasone. If dexamethasone is not available, alternative glucocorticoids such as prednisone, methylprednisolone, or hydrocortisone can be used. For these drugs, the total daily dose equivalencies to dexamethasone 6 mg (oral or intravenous [IV]) 21 are: Prednisone 40 mg Methylprednisolone 32 mg Hydrocortisone 160 mg Half-life, duration of action, and frequency of administration vary among corticosteroids. Long-acting corticosteroid : dexamethasone; half-life: 36 to 72 hours, administer once daily. Intermediate-acting corticosteroids : prednisone and methylprednisolone; half-life: 12 to 36 hours, administer once daily or in two divided doses daily. Short-acting corticosteroid : hydrocortisone; half-life: 8 to 12 hours, administer in two to four divided doses daily.
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