Evolving perspectives on corticosteroid use in  COVID-19: From pre- to post-vaccination era

Harshitha Chowdary Chebrolu; Venkata Sathvik Reddy; Zhainagul Kalmamatova; Mukesh Kumar Patwa; Srinivasa Chakradhar Earni; Krishna Priya Kanteti

Harshitha Chowdary Chebrolu Student, Department of General Medicine, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
Venkata Sathvik Reddy Student, Department of General Medicine, International Higher School of Medicine, Bishkek, Kyrgyzstan
Zhainagul Kalmamatova Assistant Professor, Department of Obstetrics and Gynecology, B N Yeltsin Kyrgyz-Russian Slavic University, Bishkek, Kyrgyzstan
Mukesh Kumar Patwa Senior Resident Doctor, Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
Srinivasa Chakradhar Earni Student, Department of General Medicine, International Higher School of Medicine, Bishkek, Kyrgyzstan
Krishna Priya Kanteti Doctor, Department of General Medicine, Gandhi Medical College and Hospital, Secunderabad, Telangana, India

Keywords: Corticosteroids, COVID-19, Dexamethasone, Cytokine storm, Acute respiratory distress syndrome, Mortality

Abstract

In treating severe COVID-19, especially for patients requiring respiratory support, corticosteroids such as dexamethasone are crucial because of their anti-inflammatory properties that counter the “cytokine storm,” which exacerbates respiratory issues and can lead to acute respiratory distress syndrome. The RECOVERY trial indicated that dexamethasone significantly reduced mortality in patients on invasive mechanical ventilation and those receiving oxygen, but no survival benefit was observed in mild cases without oxygen support. The effectiveness of corticosteroids depends on the timing, dosage, and disease severity, with early administration or higher doses linked to increased mortality. They may also prolong viral shedding and increase the risk of secondary infections and complications such as hyperglycaemia and osteonecrosis. With widespread vaccination, the necessity for corticosteroids has decreased, as vaccinated individuals generally experience milder symptoms, although severe illness persists among the unvaccinated and those with breakthrough infections. Corticosteroids are commonly used for severe cases in Asia and Central Asia, which is consistent with WHO recommendations. Their adoption is influenced by the regional healthcare infrastructure, resources, and cultural factors. Future research should refine corticosteroid use by considering new variants and patient-specific factors and optimise combination therapies for better safety and efficacy.

How to cite this article:
Chebrolu H C, Reddy V S, Kalmamatova Z, Patwa
M K, Earni S C, Kanteti K P. Evolving perspectives
on corticosteroid use in COVID-19: From
pre- to post-vaccination era. J Commun Dis.
2025;57(2):178-183

DOI: https://doi.org/10.24321/0019.5138.202553

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