Last update and review: April 4, 2020.
The use of corticosteroids at early stages of a viral infection such as COVID-19 is questionable. As explained in another article on this website, the window in which steroids might be beneficial to patients with COVID- 19 is very narrow. In other words, steroids can only be used when SARS-CoV-2 has already been eliminated by the human immune response. Otherwise, SARS-CoV-2 replication will be boosted leading to exacerbation of symptoms, substantial virus shedding, as well as increased risk for nosocomial transmission and secondary infection (based on Yuen et al., 2020, ref. 26 in another article on this website).
Yet, we see a systematic use of steroids at early stages of COVID-19 by doctors in China and elsewhere. A case report (1) is another example of that. Steroids were used in a patient with cancer who was already immunosuppressed (1):
Treatment with antiviral and corticosteroid therapies did not fully resolve his symptoms.
The same team of doctors later used another drug, tocilizumab, and the patient recovered (1):
After one intravenous administration of tocilizumab, the patient’s IL-6 levels decreased. Three days after tocilizumab treatment, his chest tightness had resolved; 10 days later, his CT scan had cleared and he was discharged from the hospital.
Sheppard et al., 2017 (2):
Tocilizumab (TCZ), is a recombinant humanized anti-interleukin-6 receptor (IL-6R) monoclonal antibody which has a main use in the treatment of rheumatoid arthritis, systemic juvenile idiopathic arthritis (sJIA) and polyarticular juvenile idiopathic arthritis (pJIA).
Tocilizumab (TCZ) is a “Big Pharma’s” potential blockbuster drug for treating COVID-19. However, if it really works, it is a good thing. Especially if it also works in immunosuppressed patients.
Selected references:
1. Case Study: Treating COVID-19 in a Patient with Multiple Myeloma.
https://www.hematology.org/newsroom/press-releases/2020/case-study-treating-covid-19
Accessed on April 4, 2020.
2. Sheppard M, Laskou F, Stapleton PP, Hadavi S, Dasgupta B. Tocilizumab (Actemra). Hum Vaccin Immunother. 2017;13(9):1972–1988. doi:10.1080/21645515.2017.1316909