COVID-19 HASTALARINDA KORTİKOSTEROİD TEDAVİSİ: NE ZAMAN VE NASIL?

Year 2021, Volume: 28 Issue: COVİD-19 ÖZEL SAYI, 197 - 208, 01.05.2021

Münire Çakır , Mehtap Çakır

https://doi.org/10.17343/sdutfd.905323

Cited By: 1

Abstract

Çin’in Wuhan şehrinde ilk vakanın görülmesinden bu yana COVID-19 dünyada 2,7 milyondan fazla insanın hayatını kaybetmesine neden olmuştur. COVID-19’a bağlı ölümün başlıca nedenleri ARDS, sepsis ve/veya septik şoktur. Hastalığın etkinliği kanıtlanmış bir tedavisi henüz mevcut değildir. COVID-19’a bağlı oluşan hiperinflamasyon ve sitokin fırtınasının kontrolünde sentetik kortikosteroidlerin etkili olabileceği düşünülmüş ve klinik çalışmalar bu grup ilaçların mortaliteyi ve mekanik ventilasyon ihtiyacını azaltmada etkili olduklarını göstermiştir.
Dünya Sağlık Örgütü, ciddi ve kritik hastalarda kortikosteroidlerin kullanımını güçlü öneri ile desteklerken ciddi olmayan hastalıkta kullanımdan kaçınılmasına koşullu öneri getirmiştir. Bu öneriler, sekiz randomize kontrollü çalışmanın sonuçlarına dayanmaktadır. Şu ana kadar yapılan çalışmalarda, tedavide en sık tercih edilen kortikosteroid molekülü metilprednizolon olmakla birlikte, deksametazon, hidrokortizon ve diğer sentetik glukokortikoidler de kullanılmaktadır. Kortikosteroidlerin mortalite üzerine etkilerinin ortaya konulduğu çalışmalarda genellikle düşük-orta dozda ilaç kullanılmış olup doz karşılaştırmalarının yapıldığı prospektif çalışmalar literatürde henüz mevcut değildir.
Kortikosteroid tedavisi ile ilgili çekincelerden biri, tedavinin viral klirens üzerine etkisidir. Düşük dozda kortikosteroidlerin viral klirens üzerine az etkileri olduğu ya da etkilerinin olmadığı bildirilmekle birlikte, yüksek doz uygulamaların viral klirens üzerine etkisi ve yine gecikmiş viral klirensin klinik önemi net değildir. Kortikosteroidlerin en sık yan etkileri olan hiperglisemi ve sekonder bakteriyel infeksiyonlar yönünden hastaların yakın takip edilmeleri ve ciddi-kritik COVID-19 hastalarında, kritik-hastalıkla ilişkili kortikosteroid yetmezliği de bulunabileceğinden, tedavinin dikkatlice kesilmesi büyük önem taşımaktadır.
COVID-19 tedavisinde kullanılacak kortikosteroidlerin türü, ideal zamanlaması, dozu, diğer ilaçlarla birlikte kullanımı konularında ve oluşabilecek muhtemel yan etkiler açısından daha fazla araştırmaya gerek vardır.

Keywords

COVID-19, Tedavi, Kortikosteroidler, Deksametazon, Metilprednizolon

CORTICOSTEROID TREATMENT OF COVID-19 PATIENTS: WHEN AND HOW?

Abstract

COVID-19 caused death of more than 2,7 million people all over the world since the first case seen in the Wuhan city of China. The primary causes of death due to COVID-19 are ARDS, sepsis and/or septic shock. There is no proven effective therapy for COVID-19 yet. It was considered that synthetic corticosteroids may be effective in the control of hyperinflammation and cytokine storm due to COVID-19 and clinical trials have shown that this group of drugs are effective in reducing mortality and need of mechanical ventilation.
World Health Organisation made a strong recommendation for sistemic corticosteroid therapy in patients with severe and critical COVID-19 and a conditional recommendation not to use corticosteroid therapy in patients with non-severe COVID-19. These recommendations are based on the results of eight randomised controlled trials. Although the most widely preferred corticosteroid molecule in the trials till now was methylprednisolone; dexamethasone, hydrocortisone and other synthetic glucocorticoids are also used. In studies revealing the effect of these drugs on mortality, generally low to moderate doses are used and comparative prospective studies of dosing do not exist in literature yet.
One of the drawbacks of corticosteroid treatment is the effect of treatment on viral clearance. Although low-dose steroids are reported to have little or no effect on viral clearance, the effect of applying high doses on viral clearance as well as the clinical importance of delayed viral clearance are not clear. Follow-up of patients for the most frequent side effects such as hyperglycemia and secondary bacterial infections and a cautious dose tapering, since critical illness related corticosteroid insufficiency may exist in patients with severe-critical COVID-19, are of paramount importance.
More investigations are needed about the type, optimal timing and dosing of steroid preparations for COVID-19 treatment as well as usage of them with other drugs and potential side-effects.

Keywords

COVID-19, Treatment, Corticosteroids, Dexamethasone, Methylprednisolone

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