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

Critically ill patients with COVID-19 face a higher risk of disease progression and complications. The current standard of 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 per day 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 Health Organization (WHO) performed a meta-analysis. The study showed that the use of systemic corticosteroids compared with routine care placebo was associated with a decrease in all-cause, 28-day mortality. With respect to the effectiveness of remdesivir, the ACTT-1 trial found that the drug conferred a benefit on time to clinical improvement. The subgroup analysis in the clinical trial also showed a benefit per mortality in patients requiring supplemental oxygen, albeit not those in need of mechanical ventilation.