Ever wondered about how steroids are effective in Covid-19?

-By Monika Sachan

Before knowing it’s, uses in Covid-19, let us know how helpful steroids are to reduce inflammation?

 Steroids are known as hormones, which are a man-made version of chemicals and are naturally made in the human body. Steroids are designed to act like these hormones to reduce inflammation known as corticosteroids and are different from anabolic steroids used by bodybuilders and athletes.

Steroids are very good at reducing inflammation and can erase symptoms like swelling, pain, and stiffness but it will not cure your condition.

Your body naturally reacts to bacteria and infection, the immune system produces extra fluid to fight infection or bacteria, which causes swelling, redness, and heat in the affected area this is usually known as inflammation, and steroids are good at reducing such kind of inflammation.

Steroids can also be used to reduce the immune reaction, the immune system which produces inflammation in the joints or other parts of the body by mistake that causes permanent damages if not cared for.

Let us know about Corticosteroids and their uses in Covid-19?

Corticosteroids are low-cost anti-inflammatory drugs and are closely mimic cortisol. These hormones are naturally produced by the adrenal glands in human and are commonly used in treatments for rheumatological inflammatory conditions:

  • Inflammation of blood vessels
  • Chronic arthritis and lupus
  • Kidney inflammation
  • Inflammations of muscles
  • Eye inflammation
  • Lung diseases

There are three types of corticosteroids commonly used – Dexamethasone, Hydrocortisone, and Methylprednisolone.

The Oxford researchers leading the Recovery clinical trials in the UK have announced that dexamethasone reduced death by up to one-third in hospitalized Covid-19 patients who develop acute respiratory complications.

Do you know how Corticosteroids acts in Covid-19 cases?

The World Health Organization (WHO) has issued new guidelines on the use of corticosteroids for the treatment of novel coronavirus infection.

Analysis of Corticosteroids – An analysis of eight trials has found corticosteroids reduce mortality among severely ill Covid-19 patients. Following by the meta-analysis that pooled data from eight randomized clinical trials, the

WHO has made two recommendations:

  • Corticosteroid therapy is used for 7 to 10days in patients with severe and critical covid-19.
  • Not to use in patients with non-severe Covid-19.

Look at some newly published meta-analysis –

The WHO rapid Evidence evaluation for covid-19 Therapies Working Group last week published a meta-analysis in JAMA on the association between the systemic administration of corticosteroids and mortality among critically ill patients with Covid-19.

The final meta-analysis included seven trials with patients having are been recruited from France, Australia, Denmark, New Zealand, Spain, Canada, Netherland, Brazil, China, Ireland, the US, the UK.

The researchers have classified the trials based on high and low dose:

  1. Dexamethasone at low and high doses
  2. Low-dose hydrocortisone
  3. High-dose methylprednisolone

Look at the important guidelines recommended by WHO on Covid-19 –

  • WHO has recommended systematic corticosteroids rather than no systemic corticosteroids for the treatment of patients with severe and critical COVID-19.
  • WHO has also highlighted that in contrast to other experimental treatment that is “difficult” and “expensive” to obtain and require “advanced medical infrastructure”, corticosteroids are “low cost, easy to administer, and readily available globally.
  • Systemic corticosteroids are among a relatively small number of interventions for covid-19 that have the potential to reduce inequities and improve equality in health.
  • WHO suggests not to use corticosteroids in the treatment of patients with non-severe Covid-19. It pointed out that especially the patients who are hospitalized for isolation purpose, they should not be treated with systemic corticosteroids.
  • The non-severe Covid-19 patients who are already being treated with systemic corticosteroids for other reasons chronic autoimmune disease and COPD need not discontinue the course.

National Institutes of health also believe in the theoretical explanation of combination therapy of corticosteroids and an antiviral agent but the clinical trials are not rigorously studied in this topic.

For more details, visit https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/immunomodulators/corticosteroids/

https://www.nature.com/articles/s41565-020-0752-z

How Dexamethasone nanomedicines may help to manage severity of Covid-19
source: https://www.nature.com/articles/s41565-020-0752-z

What do you think about the use of steroids?

There are multiple ways of taking steroids for many different types of arthritis and related conditions, as shown below :

By mouth –

  • Tablets, liquids, dissolvable tablets, also known as oral steroids.
  • It reduces inflammation throughout the whole body.
  • It is used in conditions of Rheumatoid arthritis lupus, gout, other types of inflammatory arthritis, or autoimmune conditions.
  • Commonly named as prednisolone, betamethasone, dexamethasone.

By injection –

  • Injects into a joint, muscle, the blood, or spinal area.
  • It reduces inflammation in the area of the body where the injection is given.
  • Used in conditions of Rheumatoid arthritis, lupus, gout, other types of inflammatory arthritis, or autoimmune conditions.
  • Commonly named methylprednisolone, triamcinolone, hydrocortisone.

By eye –

  • Used as drops or ointments
  • It reduces inflammation in the eyes.
  • Used in conditions of Uveitis
  • Commonly named as prednisolone.

By applying in the skin –

  • Applied to the skin as cream or gel, also known as topical steroids.
  • It reduces inflammation on the skin.
  • Used in conditions of Psoriatic arthritis and psoriasis.
  • Commonly named as hydrocortisone, mometasone, betamethasone, clobetasol.

What Side-effects may cause if you take steroids for a longer period of time?

Effects and side-effects are with all medicines, but it is more likely to be with you if you are on a high dose or taking steroids for a long time. The person who is treating you will make sure you are on the lowest possible dose to keep your conditions under control.

Here are some side effects of steroids to show:

Tablets, liquids, and soluble tablets

  • May give you stretch marks
  • Bruising easily
  • You may gain weight and also increasing of appetite
  • Can cause stomach pains, indigestion, or heartburn
  • Thinning of the skin
  • Can get sleeping problems

Eye drops and ointments

  • May cause eye burnings after putting drops in
  • Will get a funny taste in mouth after putting the drops in

Creams and gels

  • May cause change is skin color
  • May give stretch marks
  • Increased in hair growth where the cream has been applied
  • May feel stinging or burning where the cream has been applied

Some other complications –

Steroids treatments may cause several changes in mood as feeling very high or low. The chances of having it more if you are having a previous history of mood disturbance.

Taking steroid tablets for a longer period of time increases the tendency of giving you an infection. It also makes your muscles weak, affects the periods in women.

Usually, the steroid creams and eye drops do not cause any serious side effects, but if you are taking them for a longer period of time or at a high dose then it could get absorbed in your blood and would increase the risk of side effects.

Steroids sometimes affect diabetes, raised blood sugar in people if consumed for a long time. Steroids can also cause eye effects such as making glaucoma worse or causing cataracts. If you observe your eyes becoming blurry or any changes in eyesight, then for a sure consult with your doctor as soon as possible.

If we talk about teenagers, then steroids in them can cause a slow down in growth and due to this several other problems might come around. They will need to have their height checked regularly.

Is it possible to prevent the side-effects?

  • It is important to maintain your weight, as steroids can increase your appetite. Choosing sensible healthy foods and regular physical activities will help you to avoid putting weight.
  • To help to prevent bones weakening, the doctor may advise you to take drugs called bisphosphonates or calcium and vitamin D supplements along with some regular exercises especially things that involve your bones carrying the weight of your body.
  • Make sure about involving enough calcium in the diet, and avoid too much-drinking alcohol and smoking.

How do Steroids work on Fertility, Pregnancy, and breastfeeding?

You should discuss with your doctor, before planning for a family as the mother needs to stay healthy during pregnancy. Do not stop taking steroids during pregnancy if you have spoken to your doctor.

Although no research says that steroids are harmful to babies, so guidelines say that people can breastfeed while taking steroid tablets. Still without taking a risk consult with your doctor for more concerns.

During pregnancy, steroid creams are safe to use but if you are breastfeeding then you will have to make sure to wipe off the cream before feeding. Usually, strong steroids are not prescribed during pregnancy or breastfeeding. 

Ever know how steroids act in bodybuilding?

Know how Anabolic steroids help in improving muscles – Anabolic steroids are drugs that should not be taken without prescribed. But still, some people take it without medical advice to increase muscle mass and to improve athletic performance.

These prescription drugs are also used for the treatment of delayed puberty, wasting conditions, and osteoporosis. But these drugs are often illegally used by bodybuilders, weightlifters, and also competition various sports without prescription.

How Anabolic steroids are used by Athletes?

Anabolic steroids are especially used by the athletes for whom strength and speed are important competitive characteristics. In competitive bodybuilding, the most desired part is increasing muscle mass and decreasing body fat.

In this modern era, professional athletes try to avoid the common steroids and use more sophisticated methods, involving natural testosterone and human growth hormone are more difficult to detect in abnormal amounts in urine or blood tests, Anabolic steroids can be detected easily.

Sources:

https://www.verywellfit.com/anabolic-steroids-bodybuilding-and-weight-training-3498211

https://www.versusarthritis.org/about-arthritis/treatments/drugs/steroids/

https://indianexpress.com/article/explained/explained-how-steroids-act-in-covid-cases/

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