steroids in autoimmun patients who infected with COVID19
There are many patients who used Predlon for many reasons , autoimmune disease, if they are infected by COVID19, is there any changing of the usual dosage ?
It seems controversial. Steroids, however, would seem to attenuate the excess response of the immune system which is the harbinger of many side effects due to SARS-Cov-2 infection.
Steroids may adversely influence the processes acting to inhibit virus replication, by suppressing the overall inflammatory response (e.g. interferon). Nevertheless, a short course of topical steroids (e.g., dexamethasone) may be useful for patients with acute pneumonia (related to cytokine storm)!
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we consider patients on steroids in the immunocompromised group- and discharge them from hospital after PCR negative (as per our national policy).
The steroids of underlying illness is continued in same dose with strict monitoring for vitals
Patients on steroids for preexisting diseases are to be continued to take steroids in their maintenance dosage. And for COVID-19, in fact, steroids are not a common option for treatment. It is used in very severe cases with or predicting cytokine storm only. In those particular cases, methylprednisolone can be used with simultaneous hemodynamic and glycemic monitoring and control.
In Pharmacology, once there is a comorbidity and the initial drug is an essential drug such as in Dexa in Autoimmune issues, the dosage is left at its initial tolerance level.. and the new infection is observed.. naturally considering that the human body does not exhibit larger surface area or sudden jump in Volume, the dosages do not change..
Steroid's schedule in autoimmune patients with COVID-19 shud be coorrected taking to account clinical course of disease.
Prednisolone is used as a Life Saving drug ( LSD ) for Covid19 - let us have a look
the effect of Immunity system - https://www.webmd.com/lung/covid-and-autoimmune-drugs
For COVID-19 treatment, our national protocol includes steroids for moderate and severe cases
Matteo Nioi Pietro Emanuele Napoli it looks so logical , I understand the role of steroids in suppressing the inflammation, but the challenge, do we need to modify the dosage or not ?
Pranav Ish Idowu Goodnews Oluwaseyi so we don't need to modify the dosage
Chumak Anatolii so dear doctor is there any studies in this field you suggest !
Jaydip Datta so you suggest prednisolone instead of dexamethasone ?
As you know, prednisolon is the choice for most of autoimmune diseases
Md Rabiul Alam so it looks acceptable with what Jaydip Datta suggests !
Clinical trials are needed to uncover these important details.
Pietro Emanuele Napoli sure
I think more studies will applied after this pandemic go away not now in the acute phase of spread in the time most efforts directed for treatment and vaccination
Idowu Goodnews Oluwaseyi yes I say so it doesn't need to be modified
It really depends upon the severity of symptoms. Most of the COVID-19 patients are asymptomatic so no dose alteration should be done but in severe symptoms dosage can be increased where the benefits of prednisolone outweighs the risks. Being a general medicine doctor its what I personally think.
It should be individual. Not necessary to change dosage. However, therapist can change dose for some reason and depend on symptoms.
It has been announced that the common arthritis drug, dexamethasone, can help save the lives of people who are seriously ill with COVID-19.
Dexamethasone is a type of corticosteroid, which is commonly used to reduce inflammation in people with inflammatory arthritis or autoimmune conditions like rheumatoid arthritis, lupus and gout.
Research into using this drug to treat coronavirus was conducted as part of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial by the University of Oxford to test a range of potential treatments for COVID-19.
Due to the immune-suppressing properties of dexamethasone, researchers decided to test its effectiveness in treating coronavirus patients with severe respiratory symptoms.
Researchers found that dexamethasone reduced deaths by one-third in ventilated patients, and by one fifth in other patients receiving oxygen only. There was no benefit among those patients who did not require respiratory support.
Dexamethasone is a readily accessible drug, and the first that’s shown to improve survival rates in COVID-19.
While it is effective for treating coronavirus patients requiring respiratory support for severe respiratory symptoms, guidelines should still be followed for people taking the drug to treat inflammatory or autoimmune conditions.
Zeina A.Althanoon the initial recommendation of the dosage of dexamethasone 6mg for 10 days ! so do we need to modify this dosage in specific conditions ?
I would be extremely cautious to use steroids in mild cases of Covid-19, given the data that steroids upregulate ACE2 expression and could increase Covid severity. However, in those with moderate to severe Covid, there is certainly a role for dexamethasone.
While steroids are double-edged swords in infectious diseases, there are some evidences that combination of corticosteroids, antibiotics, IVIG is useful in patients with COVID-19. In patients with autoimmune disorders, the dosage of steroids should be noticed in order to prevent both recurrence of symptoms and weakening of immune system.
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https://www.benaroyaresearch.org/blog/post/covid-19-coronavirus-14-things-people-autoimmune-disease-should-know
It depends on the patient's condition and his or her response to the steroidal treatments.
Hope there is sufficient data available to establish a reliable guideline
Ankur Jain I really prefer to avoid steroids, but patients with autoimmune in need of these group of drugs and I accept doctors there's no need to modify the usual dosage in such patients
I think steroids are useful with regards to reducing inflammation caused by cytokine storm attributed to Covid 19 infections, wherein controlling or reducing inflammation will contribute to the reduction of tissue damage particularly endothelium of the blood vessels.
Please check the slide with the statistical information: after 6 months of pandemic statistics of covid-19 cases have been showing fantastic stability in being largely confined to the 30-50 degree belt (92%-97% of the world's totals).
Fatima Alhamed Alduihi there is no need to use steroid in mild covid cases but they have certainly some benefits if you use it in moderate cases. In severe cases steroid is the only effective drug till date. You may see the recommendations of recent trials.
Currently, the World Health Organization (WHO) advises against the administration of corticosteroids to patients with SARS-CoV-2 infection due to the poor outcomes observed with corticosteroids in patients with SARS-CoV and Middle East respiratory syndrome (MERS-CoV), unless corticosteroids are necessary for a coexisting disease
Currently, the WHO advises that corticosteroids not be administered to patients with COVID-19, but does allow for their use in patients with preexisting conditions. Judicious use of steroids in the setting of COVID-19 was originally suggested in response to poor outcomes in previous viral outbreaks. such as SARS-CoV and MERS-CoV .Although corticosteroids have been tested due to their potential ability to prevent inflammatory lung injury, their use was not advantageous and led to serious adverse reactions. Patients with SARS-CoV and MERS-CoV who were treated with corticosteroids had higher plasma viral loads, suggesting delayed viral clearance due to corticosteroid impairment of the host immune system. In addition, SARS-CoV patients treated with higher cumulative doses of corticosteroids were found to be more likely to develop complications, such as psychosis, diabetes, osteoporosis and avascular necrosis [14–16]. Systemic reviews of previous viral outbreaks and during the current SARS-CoV-2 pandemic have found that corticosteroid use was not advantageous in the past and requires further research to warrant their use for treatment of SARS-CoV-2
Few studies to date have investigated steroid use in COVID-19 illness, with those studies limited by small sample sizes and inconclusive or conflicting results. In one study, a short course of low dose methylprednisolone improved outcomes in severe COVID-19 patients in the ICU by shortening supplemental oxygen use, reducing the need for mechanical ventilation and shortening ICU and hospitalization stay when compared with a control group
Another study found that steroid treatment failed to show benefits in 15 critically ill patients with COVID-19 pneumonia, whereas other studies did not report definitive results . Most of these studies are similar, in that they involve small sample sizes and administration of corticosteroids to critically ill patients, suggesting that they may be somewhat limited by the potential of confounding bias. Overall, these studies do not provide sufficient evidence to support routine corticosteroid use in COVID-19
However, the National Institute for Health and Care Excellence (NICE) has developed guidelines to specifically assist in the management of gastrointestinal and liver diseases during the COVID-19 pandemic.These guidelines recommend that oral or rectal corticosteroids to treat compelling gastrointestinal or liver conditions not be discontinued when a patient is diagnosed with COVID-19. These guidelines are in accordance with WHO recommendations that allow for corticosteroid treatment of preexisting conditions in COVID-19 patients.
Although corticosteroids resulted in poor outcomes in previous SARS-CoV and MERS-CoV outbreaks and are not recommended for use in patients with COVID-19, our patient did not experience additional COVID-19 complications despite having multiple risk factors
It seems to me that corticosteroid treatment of Covid-19 is not a good idea.
https://www.researchgate.net/post/Covid-19_Erythropoietin_EPO_deficiency_syndrome2
Please check our slide prooving the existance of common "Zero source" of the current COVID-19 pandemic. The rest works concerning the issue can be found in my profile.
Poster Evidence from Astrobiology for COVID-19 cosmic origin