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Review
. 2022 Feb 15:13:813358.
doi: 10.3389/fmicb.2022.813358. eCollection 2022.

Role of Dexamethasone and Methylprednisolone Corticosteroids in Coronavirus Disease 2019 Hospitalized Patients: A Review

Jyoti Mehta  1 , Rajan Rolta  1 , Brij Bhushan Mehta  2 , Neha Kaushik  3 , Eun Ha Choi  4 , Nagendra Kumar Kaushik  4
Affiliations
Review

Role of Dexamethasone and Methylprednisolone Corticosteroids in Coronavirus Disease 2019 Hospitalized Patients: A Review

Jyoti Mehta et al. Front Microbiol. .

Abstract

The WHO announced coronavirus disease 2019 (COVID-19) as a pandemic disease globally on March 11, 2020, after it emerged in China. The emergence of COVID-19 has lasted over a year, and despite promising vaccine reports that have been produced, we still have a long way to go until such remedies are accessible to everyone. The immunomodulatory strategy has been kept at the top priority for the research agenda for COVID-19. Corticosteroids have been used to modulate the immune response in a wide range of diseases for the last 70 years. These drugs have been shown to avoid and reduce inflammation in tissues and the bloodstream through non-genomic and genomic effects. Now, the use of corticosteroids increased the chance of survival and relief by combating the viral strong inflammatory impacts and has moved to the forefront in the management of patients seeking supplemental oxygen. The goal of this review is to illuminate dexamethasone and methylprednisolone, i.e., in terms of their chemical and physical properties, role in COVID-19 patients suffering from pneumonia, the proposed mode of action in COVID-19, pharmacokinetics, pharmacodynamics, clinical outcomes in immunocompromised populations with COVID-19, interaction with other drugs, and contradiction to explore the trends and perspectives for future research. Literature was searched from scientific databases such as Science Direct, Wiley, Springer, PubMed, and books for the preparation of this review. The RECOVERY trial, a massive, multidisciplinary, randomized, and open-label trial, is mainly accountable for recommendations over the usage of corticosteroids in COVID-19 patients. The corticosteroids such as dexamethasone and methylprednisolone in the form of medication have anti-inflammatory, analgesic, and anti-allergic characteristics, including the ability to inhibit the immune system. These drugs are also recommended for treating symptoms of multiple ailments such as rheumatic and autoimmune diseases, leukemia, multiple myeloma, and Hodgkin's and non-Hodgkin's lymphoma along with other drugs. Toxicology studies proved them safe usually at low dosage via oral or other routes.

Keywords: COVID-19; corticosteroids; dexamethasone; inflammatory impacts; methylprednisolone; pharmacodynamics; pharmacokinetics.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Structure of 9α-fluoro-16α-methylprednisolone (dexamethasone). This figure is made using ChemDraw.
FIGURE 2
FIGURE 2
Structure of 11β,17,21-trihydroxy-6α-methylpregna-1,4-diene-3, 20-dione (methylprednisolone). This figure is made using ChemDraw.
FIGURE 3
FIGURE 3
Pictorial representation of pathological events that occurred during COVID-19 and the efficacy of corticosteroid to control COVID-19 infection. SARS-CoV-2 gets inside the host via the pulmonary route, penetrates the alveoli, and interacts with alveolar macrophages (AMs) and pneumocytes (P). Infectious AMs release cytokines/chemokines that recruit and trigger other immune cells such as T cells (T) to produce cytokines, causing “cytokine storm,” and monocytes (M) along with neutrophils (N) move from the blood to the infection site. The lungs in COVID-19 cases in severe condition at late stage lead to acute respiratory distress syndrome (ARDS) and pulmonary fibrosis. Corticosteroids help in inhibiting inflammation caused by cytokine storms and prevent several problems associated with severe COVID-19 including pneumonia, edema, ARDS, and fibrosis. Adapted and modified from Gopalaswamy and Subbian (2021) with permission.
FIGURE 4
FIGURE 4
Mechanism of COVID-19 and corticosteroid action is adapted and modified from Yang Yang J.W. et al. (2020).
FIGURE 5
FIGURE 5
Structure of naturally occurring compounds such as thymoquinone (A), resveratrol (B), and curcumin (C). These structures are prepared using ChemDraw software.
See this image and copyright information in PMC

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