Therapeutic alert - Corticosteroids in the treatment of suspected or confirmed COVID-19

Following recent publication of the REMAP-CAP trial for hydrocortisone and a meta-analysis of corticosteroids, the World Health Organization (WHO) has recently issued new interim guidance recommending the use of systemic corticosteroids in severe and critical COVID-19 disease.

Corticosteroids, and in particular dexamethasone and hydrocortisone, have been demonstrated to have a place in the management of patients with COVID-19.

The revised WHO recommendations for the use of dexamethasone or hydrocortisone in the management of patients with severe or critical COVID-19 are provided below:

  1. a strong recommendation for systemic (intravenous or oral) corticosteroid therapy in patients with severe and critical COVID-19, and 
  2. a conditional recommendation not to use corticosteroid therapy in patients with non-severe COVID-19.

It should be noted that the WHO guidance is intended to apply globally, and that healthcare conditions can vary significantly from country to country. In the UK setting, the WHO guidance is likely to apply primarily to patients with COVID-19 who are hospitalised and receiving supplemental oxygen. However, there may be occasions when UK patients with COVID-19 meet the WHO criteria of severe or critical but are not hospitalised, in which case the WHO guidance for treatment would apply.

For further information, please refer to the therapeutic alert in the download section.