Steroids and COVID-19: We Need a Precision Approach, Not One Size Fits All
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LETTER
Steroids and COVID-19: We Need a Precision Approach, Not One Size Fits All Grant W. Waterer . Jordi Rello
Received: August 12, 2020 Ó The Author(s) 2020
ABSTRACT COVID-19 is a new infectious disease causing severe respiratory failure and death for which optimal treatment is currently unclear. Many therapies have been proven to be ineffective; however, promising findings related to corticosteroid therapy have been published. Analysis of published data including in this issue suggests that therapy with corticosteroids in the range of 6 mg of dexamethasone (or equivalent) per day likely has a positive effect in patients requiring mechanical ventilation but there remains considerable doubt in patients over the Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12867233. G. W. Waterer (&) University of Western Australia, Perth, Australia e-mail: [email protected] G. W. Waterer Northwestern University, Chicago, IL, USA J. Rello Centro de Investigacio´n Biomedica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain J. Rello Vall d’Hebron Institute of Research (VHIR), Barcelona, Spain J. Rello Clinical Research, CHU Nıˆmes, Universite´ Montpellier-Nıˆmes, Nıˆmes, France
age of 70, in patients with diabetes and patients with milder disease. Clinicians must consider the individual potential risks and benefits of corticosteroid in patients with COVID-19 rather than routinely using them until more data is available.
Keywords: ARDS; Coronavirus; Covid-19; Pneumonia; Precision medicine; RCT; SARS; Therapy Key Summary Points Steroids should not be given to every patient with COVID-19. More data is needed in specific patient cohorts. A benefit of corticosteroids has not been established in those over 70 years of age. Hyperglycemia is a significant risk in individuals with diabetes and this subgroup of patients has not been well studied for a risk–benefit analysis of steroids. Longer outcomes than 28 days are required to properly assess whether corticosteroid therapy truly improves patient outcomes.
Infect Dis Ther
DIGITAL FEATURES This article is published with digital features to facilitate understanding of the article. To view digital features for this article go to https://doi. org/10.6084/m9.figshare.12867233. COVID-19 has posed a challenge not seen in the western world from an infectious disease since at least the polio epidemics of the 1940s and 1950s and in scale of mortality and morbidity not since the 1918 influenza pandemic. The initial response by the medical and scientific community was far less than exemplary. Tens if not hundreds of thousands of patients have been given a huge array of experimental therapies in all kinds of combinations, often with minimal scientific support of efficacy, in a completely haphazard manner that prohibits any assessment of their effect on outcomes [1]. Across multiple countries physicians unlearnt decades of progress in evidence-based medicine in the face of a new challenge and a desperate desire to ‘‘do so
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