What we have to know about corticosteroids use during Sars-Cov-2 infection.
J Endocrinol Invest
; 44(4): 693-701, 2021 Apr.
Article
in English
| MEDLINE | ID: covidwho-734036
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
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pituitary-Adrenal System
/
Adrenal Cortex Hormones
/
SARS-CoV-2
/
COVID-19 Drug Treatment
/
Hypothalamo-Hypophyseal System
Type of study:
Prognostic study
Limits:
Humans
Language:
English
Journal:
J Endocrinol Invest
Year:
2021
Document Type:
Article
Affiliation country:
S40618-020-01384-5
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