Steroid therapy and antiviral treatment in SARSCoV-2 pneumonia: clinical contexts and indications

ABSTRACT

Critically ill patients with COVID-19 face a higher risk ofdisease progression and complications. The current standardof care includes supportive care measures and fluid management. The Recovery trial observed a reduction in all-cause,28-day mortality (p<0.001) when patients with COVID-19 requiring oxygen therapy received 6 mg of dexamethasone perday for 10 days. In contrast, in patients not requiring oxygen,no benefit was observed 28-day mortality rates for the dexamethasone and routine care groups were 17.8% and 14%,respectively. To corroborate these results, the World HealthOrganization (WHO) performed a meta-analysis. The studyshowed that the use of systemic corticosteroids comparedwith routine care placebo was associated with a decrease inall-cause, 28-day mortality. With respect to the effectivenessof remdesivir, the ACTT-1 trial found that the drug conferred abenefit on time to clinical improvement. The subgroup analysisin the clinical trial also showed a benefit per mortality in patients requiring supplemental oxygen, albeit not those in needof mechanical ventilation. (AU)