Role of Steroids and Other Immunomodulators in Treatment of COVID-19

Abstract

Coronavirus disease 2019(COVID- 19), the newly discovered infectious disease is caused by an infection with a novel virus belonging to the family Coronaviridae named severe acute respiratory syndrome coronavirus-2(SARS-CoV-2). SARS-CoV-2-infected cells produce substances that can induce injury to lung cells as the focus of initiation of COVID-19 during the incubation period. These substances bind to receptors on the target cells. Corticosteroids bind to specific intracellular cytoplasmic receptors in target tissues.  The receptor hormone recruits co-activator or co-repressor proteins after dimerizing. In severe COVID-19 patients develop a systemic inflammatory response that leads to lung injury and multisystem organ dysfunction. Even though evidence consistently supporting the use of steroids in ARDS and pneumonia is hard to come by the potent anti-inflammatory effects of steroids are postulated to prevent the deleterious effects of the severe inflammation seen in COVID pneumonia. A monoclonal antibody cocktail consisting of Casirivimab and Imdevimab is another promising therapeutic option in patients at high risk of deterioration. Used early in the disease process they prevent hospitalization and further morbidity.