February 12, 2020

On the use of corticosteroids for 2019-nCoV pneumonia

Category: Article Summary

Topic: Clinical Characteristics and Health Care Setting

• Shang, et al. respond to an earlier article by Russell, et al. on clinical evidence of corticosteroid therapy in severe coronavirus infections. Shang, et al. describe the potential for selection bias and confounding in observational studies, given that usually only critically ill patients are treated with corticosteroid therapy. They further note that four references in the original articles cited as having “conclusive data…indicating harm” were not definitive, and that Russell, et al. did not address 25 other inconclusive studies. Additional studies supporting low-moderate dose corticosteroid therapy for severely ill coronavirus and influenza patients are cited.
• An expert consensus statement from the Chinese Thoracic Society identifies basic principles for corticosteroids use, including that corticosteroids can be used prudently in critically ill COVID-2019 patients, with special caution for patients with hypoxemia due to underlying diseases or who regularly use corticosteroids for chronic diseases; that dosage should be low-to-moderate (≤0·5–1 mg/kg per day methylprednisolone or equivalent); and that duration should be short (≤7 days).

Shang L, et al. (Feb 11, 2020) On the use of corticosteroids for 2019-nCoV pneumonia. The Lancet. https://doi.org/10.1016/S0140-6736(20)30361-5