What we have to know about corticosteroids use during Sars-Cov-2 infection
- PDF / 624,182 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 21 Downloads / 160 Views
SHORT REVIEW
What we have to know about corticosteroids use during Sars‑Cov‑2 infection F. Ferraù1,2 · F. Ceccato3,4 · S. Cannavò1,2 · C. Scaroni3 Received: 1 June 2020 / Accepted: 2 August 2020 © Italian Society of Endocrinology (SIE) 2020
Abstract Purpose Glucocorticoids (GCs), alone or associated to other drugs, were widely used in the management of patients affected by severe acute respiratory syndrome caused by SARS-CoV-2 infection, during the recent COVID-19 outbreak. This review summarizes the available data on HPA axis impairment in GC-treated SARS-CoV-2 patients, focusing on the risk of adrenal insufficiency and on potential drug interactions during concomitant treatments. Methods Literature on the impact of GCs therapy on HPA axis and on the consequences of coadministration of GCs and other drugs in SARS-CoV-2 patients has been reviewed. Results GC treatment can cause symptoms of hypercortisolism, especially in patients with individual hypersensibility, or hypoadrenalism after drug withdrawal, due to hypothalamic–pituitary–adrenal (HPA) axis suppression, with consequences in terms of increased morbidity and mortality risk. On the other hand, in SARS-CoV-2-infected patient’s cortisol secretion could be insufficient also due to critical illness-related corticosteroid insufficiency (CIRCI). In addition, in this clinical context, the co-administration of antiretroviral drugs and corticosteroids may trigger drug–drug interaction and enhance the exposure to the latter ones, metabolized through the CYP450 CYP3A pathway, severely impacting on HPA axis. Conclusion Physicians involved in the management of patients affected by COVID-19 should be aware of the need of an appropriate GC dose tapering, and of potential interaction of GCs with antiviral therapy and drugs used to treat associated co-morbidities. Keywords Glucocorticoid treatment · COVID-19 · SARS-CoV 2 · Drug interference · Adrenal insufficiency · Steroids · Infection
Introduction: glucocorticoids use during critical illness FF and FC should be considered jointly as first co-authors. * F. Ferraù [email protected]; [email protected] 1
Department of Human Pathology of Adulthood and Childhood ‘G. Barresi’, AOU Policlinico Gaetano Martino, UOC di Endocrinologia, University of Messina, Pad. H, 4° piano, Via Consolare Valeria, 1, 98125 Messina, Italy
2
Endocrine Unit, University Hospital G. Martino, Messina, Italy
3
Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy
4
Department of Neuroscience DNS, University of Padova, Padova, Italy
During the Covid-19 outbreak occurring in Italy in the spring of 2020, glucocorticoids’ (GCs) administration, alone or associated with other drugs, was widely used in the management of patients affected by severe acute respiratory distress syndrome (ARDS) caused by Sars-Cov-2 infection. Nevertheless, several concerns exist about this therapeutic approach in patients with viral infections. Some studies demonstrated that GCs administration increases the
Data Loading...
