Guide for the management of steroids in patients with COVID-19 of Centro Médico Docente la Trinidad

Abstract

The specific mechanism by which steroids would act on sustained lung inflammation, as well as the definition of the best drug to use and even the appropriate duration of treatment, remain the objectives of ongoing clinical trials. As clinicians, we believe that the potent anti-inflammatory properties of synthetic steroids are well defined and definitive evidence that other anti-inflammatory strategies provide better efficacy is still lacking, at least in COVID-19. Although synthetic steroids share a marked anti-inflammatory action and few mineralocorticoid effects, their bioequivalence and different kinetics should consider, due to the high variability of individual pharmacokinetics, the appropriate use and prescription of these drugs, they can trigger various effects that could negatively impact on the clinical course of the patient with COVID-19, in addition, many of the drugs currently considered in the management of the patient with coronavirus can enhance the half-life and the appearance of adverse effects of corticosteroids, or some adverse effects of these other drugs can simulate complications associated with the use of corticosteroids, which could lead to an early and untimely suspension of them. Numerous clinical studies and study articles based on narrative reviews have served as guides for clinicians in the midst of this pandemic, however, the results of these should be interpreted with caution. For this reason, we have performed an analysis based on the GRADE system of these studies to contrast the information included in the clinical studies and minimize the error of analysis.