Pathogenetic therapy of COVID-19: focus on glucocorticoids


  • M.V. Bondar Shupyk National University of Healthcare of Ukraine, Kyiv, Ukraine
  • M.M. Pilipenko Shupyk National University of Healthcare of Ukraine, Kyiv, Ukraine
  • T.V. Ovsiienko Shupyk National University of Healthcare of Ukraine, Kyiv, Ukraine; State Institution “Academician O.F. Vozianov Institute of Urology” of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
  • O.A. Loskutov Shupyk National University of Healthcare of Ukraine, Kyiv, Ukraine



COVID-19, systemic inflammatory response, pro-inflammatory cytokines, hypothalamo-pituitary-adrenal system, glucocorticoids, review


The problem of preventing excessive production of pro-inflammatory cytokines in the case of COVID-19 remains unresolved. The use of steroids in the treatment of coronavirus pneumonia remains controversial. To date, there is insufficient literature data for the routine use of steroids in COVID-19 intensive care programs, and this issue remains the subject of continuous research and endless debate. The review of the scientific literature focuses on one of the areas of pathogenetic therapy for COVID-19 — the prevention and elimination of hyperproduction of pro-inflammatory cytokines using glucocorticoid drugs. The review presents modern international recommendations on the use of glucocorticoid drugs in severe COVID-19, examines the pathogenetic mechanisms of their action and side effects.


Download data is not yet available.


Bellani G., Laffey J.G., Pham T. et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries [published correction appears in JAMA. 2016 Jul 19. 316(3). 350]. JAMA. 2016. 315(8). 788-800. doi: 10.1001/jama.2016.0291.

Elnoby A.S. Clinical Consideration of Glucocorticoids in COVID-19. J. Pharm. Pract. 2021. 34(2). 181-182. doi: 10.1177/0897190020987124.

Alexaki V.I., Henneicke H. The Role of Glucocorticoids in the Management of COVID-19. Horm. Metab. Res. 2021. 53(1). 9-15. doi: 10.1055/a-1300-2550.

Timmermans S., Souffriau J., Libert C. A General Introduction to Glucocorticoid Biology. Front Immunol. 2019. 10. 1545. Published 2019 Jul 4. doi: 10.3389/fimmu.2019.01545.

Widén C., Gustafsson J.A., Wikström A.C. Cytosolic glucocorticoid receptor interaction with nuclear factor-kappa B proteins in rat liver cells. Biochem. J. 2003. 373(Pt 1). 211-220. doi: 10.1042/BJ20030175.

Panettieri R.A., Schaafsma D., Amrani Y., Koziol-White C., Ostrom R., Tliba O. Non-genomic Effects of Glucocorticoids: An Updated View. Trends Pharmacol. Sci. 2019. 40(1). 38-49. doi: 10.1016/

Vandewalle J., Libert C. Glucocorticoids in Sepsis: To Be or Not to Be. Front Immunol. 2020. 11. 1318. Published 2020 Jul 21. doi: 10.3389/fimmu.2020.01318.

Cain D.W., Cidlowski J.A. Immune regulation by glucocorticoids. Nat. Rev. Immunol. 2017. 17(4). 233-247. doi: 10.1038/nri.2017.1.

Hadjadj J., Yatim N., Barnabei L. et al. Impaired type I interferon activity and inflammatory responses in severe COVID-19 patients. Science. 2020. 369(6504). 718-724. doi: 10.1126/science.abc6027.

Ricciotti E., Laudanski K., FitzGerald G.A. Nonsteroidal anti-inflammatory drugs and glucocorticoids in COVID-19. Adv. Biol. Regul. 2021. 81. 100818. doi: 10.1016/j.jbior.2021.100818.

Quatrini L., Ugolini S. New insights into the cell- and tissue-specificity of glucocorticoid actions. Cell Mol. Immunol. 2021. 18(2). 269-278. doi: 10.1038/s41423-020-00526-2.

Tu G.W., Shi Y., Zheng Y.J. et al. Glucocorticoid attenuates acute lung injury through induction of type 2 macrophage. J. Transl. Med. 2017. 15(1). 181. Published 2017 Aug 29. doi: 10.1186/s12967-017-1284-7.

Ferrara F., Vitiello A. Efficacy of synthetic glucocorticoids in COVID-19 endothelites. Naunyn Schmiedebergs Arch. Pharmacol. 2021. 394(5). 1003-1007. doi: 10.1007/s00210-021-02049-7.

Yaqoob H., Greenberg D., Hwang F. et al. Comparison of pulse-dose and high-dose corticosteroids with no corticosteroid treatment for COVID-19 pneumonia in the intensive care unit. J. Med. Virol. 2022. 94(1). 349-356. doi: 10.1002/jmv.27351.

Normand S.T. The RECOVERY Platform. N. Engl. J. Med. 2021. 384(8). 757-758. doi: 10.1056/NEJMe2025674.

Horby P., Lim W.S. et al.; RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with COVID-19. N. Engl. J. Med. 2021. 384(8). 693-704. doi: 10.1056/NEJMoa2021436.

Li H., Yan B., Gao R., Ren J., Yang J. Effectiveness of corticosteroids to treat severe COVID-19: A systematic review and meta-analysis of prospective studies. Int. Immunopharmacol. 2021. 100. 108121. doi: 10.1016/j.intimp.2021.108121.

Qiu T., Liang S., Dabbous M., Wang Y., Han R., Toumi M. Chinese guidelines related to novel coronavirus pneumonia. J. Mark. Access. Health Policy. 2020. 8(1). 1818446. Published 2020 Oct 8. doi: 10.1080/20016689.2020.1818446.

Bai C., Chotirmall S.H., Rello J. et al. Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020). Eur. Respir. Rev. 2020. 29(157). 200287. Published 2020 Oct 5. doi: 10.1183/16000617.0287-2020.

Bhimraj A., Morgan R.L., Shumaker A.H. et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19 [published online ahead of print, 2020 Apr 27]. Clin. Infect. Dis. 2020. ciaa478. doi: 10.1093/cid/ciaa478.

National Institutes of Health. COVID-19 treatment guidelines corticosteroids. National Institutes of Health website. Accesses October 17, 2020.

Alhazzani W., Møller M.H., Arabi Y.M. et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020. 46(5). 854-887. doi: 10.1007/s00134-020-06022-5.

World Health Organization. Corticosteroids for COVID-19. World Health Organization website. Accessed October 17, 2020.

Marik P.E., Kory P., Varon J., Iglesias J., Meduri G.U. MATH+ protocol for the treatment of SARS-CoV-2 infection: the scien­tific rationale. Expert Rev. Anti Infect. Ther. 2021. 19(2). 129-135. doi: 10.1080/14787210.2020.1808462.

Akbas E.M., Akbas N. COVID-19, adrenal gland, glucocorticoids, and adrenal insufficiency. Biomed. Pap. Med. Fac. Univ. Palacky Olomouc Czech Repub. 2021. 165(1). 1-7. doi: 10.5507/bp.2021.011.

Ding Y., Wang H., Shen H. et al. The clinical pathology of severe acute respiratory syndrome (SARS): a report from China. J. Pathol. 2003. 200(3). 282-289. doi: 10.1002/path.1440.

Gu J., Korteweg C. Pathology and pathogenesis of severe acute respiratory syndrome. Am. J. Pathol. 2007. 170(4). 1136-1147. doi: 10.2353/ajpath.2007.061088.

Leyendecker P., Ritter S., Riou M. et al. Acute adrenal infarction as an incidental CT finding and a potential prognosis factor in severe SARS-CoV-2 infection: a retrospective cohort analysis on 219 patients. Eur. Radiol. 2021. 31(2). 895-900. doi: 10.1007/s00330-020-07226-5.

Frankel M., Feldman I., Levine M. et al. Bilateral Adrenal Hemorrhage in Coronavirus Disease 2019 Patient: A Case Report. J. Clin. Endocrinol. Metab. 2020. 105(12). dgaa487. doi: 10.1210/clinem/dgaa487.

Heidarpour M., Vakhshoori M., Abbasi S., Shafie D., Re­zaei N. Adrenal insufficiency in coronavirus disease 2019: a case report. J. Med. Case Rep. 2020. 14(1). 134. Published 2020 Aug 24. doi: 10.1186/s13256-020-02461-2.

Téblick A., Langouche L., Van den Berghe G. Anterior pitui­tary function in critical illness. Endocr. Connect. 2019. 8(8). R131-R143. doi: 10.1530/EC-19-0318.

Akbas E.M., Akbas N. COVID-19, adrenal gland, glucocorticoids, and adrenal insufficiency. Biomed. Pap. Med. Fac. Univ. Palacky Olomouc Czech Repub. 2021. 165(1). 1-7. doi: 10.5507/bp.2021.011.

Panesar N.S., Lam C.W., Chan M.H., Wong C.K., Sung J.J. Lymphopenia and neutrophilia in SARS are related to the prevai­ling serum cortisol. Eur. J. Clin. Invest. 2004. 34(5). 382-384. doi: 10.1111/j.1365-2362.2004.01347.x.



How to Cite

Bondar, M., Pilipenko, M., Ovsiienko, T., & Loskutov, O. (2022). Pathogenetic therapy of COVID-19: focus on glucocorticoids. EMERGENCY MEDICINE, 18(2), 6–12.



Scientific Review

Most read articles by the same author(s)

1 2 3 4 5 6 7 > >>