CLINICAL AND PHARMACOLOGICAL ASPECTS OF APPLYING GLUCOCORTICOSTEROIDS FOR SARS-COVID-2 INFECTION: REVIEW ARTICLE

Abstract

In recent years, the SARS-CoV-2 pandemic has become one of the unexpected and very serious challenges for public health around the world. Moreover, SARS-CoV-2 infection led to the development of acute respiratory distress syndrome as a result of excessive systemic inflammation, and the development of multiple organ failure, and later death. Moreover, the problem of eliminating excessive systemic inflammation, that is, reducing the production of pro-inflammatory cytokines in SARS-CoV-2, remains open. In this regard, the use of glucocorticosteroids for infection caused by SARS-CoV-2 remains quite controversial. The basis for the routine use of steroids in intensive care protocols for SARS-CoV-2 is clearly insufficient and remains the subject of further research. This review provides an analysis of literary sources, guidelines, and modern international recommendations on pathogenetic therapy of SARS-CoV-2 to prevent and eliminate hyperproduction of pro-inflammatory cytokines using glucocorticosteroid agents. The purpose of the work is to conduct an analysis of modern literary sources regarding the modern features of the clinical and pharmacological justification of the use of glucocorticosteroids in SARS-CoV-2 infection in clinical practice. The analysis of the scientific literature demonstrates that today glucocorticosteroid therapy cannot be recommended for routine use in therapeutic practice in patients with SARS-CoV-2 infection. Thus, with a mild course of SARS-CoV-2 infection, when the patient does not need oxygen support, GCS therapy is contraindicated. With a severe course of SARS-CoV-2, when the patient develops acute respiratory distress syndrome with severe respiratory failure, when there is a need for oxygen therapy, mechanical ventilation or ECMO, the use of corticosteroids is extremely necessary, and may be recommended for mandatory use. There is a pressing need for a comprehensive definition of the optimal glucocorticosteroid agent, indications, dosage, and duration of use in SARS-CoV-2 infection therapy programs. This should be done while considering biomarkers of the severity of the inflammatory process and biomarkers of the body's response to glucocorticosteroid agents.