What we have to know about corticosteroids use during Sars-Cov-2 infection

Autor: Francesco Ferraù, Filippo Ceccato, Carla Scaroni, S. Cannavò
Rok vydání: 2020
Předmět:
Drug
Cortisol secretion
Hypothalamo-Hypophyseal System
endocrine system
medicine.medical_specialty
Adrenal insufficiency
COVID-19
Drug interference
Glucocorticoid treatment
Infection
SARS-CoV 2
Steroids
medicine.drug_class
Endocrinology
Diabetes and Metabolism
media_common.quotation_subject
Glucocorticoid treatment
Pituitary-Adrenal System
COVID-19. Drug interference
Context (language use)
Drug withdrawal
Endocrinology
Adrenal Cortex Hormones
Internal medicine
Hypoadrenalism
medicine
Adrenal insufficiency
Humans
Drug interference
Drug Interactions
Cushing Syndrome
media_common
SARS-CoV-2
business.industry
COVID-19
medicine.disease
Short Review
COVID-19 Drug Treatment
Anti-Retroviral Agents
Concomitant
Adrenal insufficiency
COVID-19. Drug interference
Glucocorticoid treatment
Infection
SARS-CoV 2
Steroids
Corticosteroid
SARS-CoV 2
Steroids
Infection
business
hormones
hormone substitutes
and hormone antagonists
Zdroj: Journal of Endocrinological Investigation
ISSN: 1720-8386
Popis: 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.
Databáze: OpenAIRE
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