key: cord-1037859-4r0zrj77
authors: Tang, Chong; Wang, Yichuan; Lv, Houshan; Guan, Zhenpeng; Gu, Jin
title: Caution against corticosteroid-based COVID-19 treatment
date: 2020-05-25
journal: Lancet
DOI: 10.1016/s0140-6736(20)30749-2
sha: 530d20b267324371879311119f3dc2525dcac45b
doc_id: 1037859
cord_uid: 4r0zrj77

nan

In December, 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei province, China, and COVID-19 has become a threat to global public health. 1 Use of corticosteroid-based therapy to reduce inflammatory-induced lung injury has been described for patients with severe COVID-19, 2,3 similar to the use of corticosteroids to treat severe acute respiratory syndrome (SARS) during the SARS outbreak in 2003. 4 However, improper use of systemic corticosteroids can increase the risk of osteonecrosis of the femoral head (ONFH).

In a retrospective study of 539 patients with SARS who received corticosteroid therapy, 5 the incidence of steroid-induced ONFH was 24%, and increased incidence of steroidinduced ONFH was associated with total corticosteroid dose and the use of more than one type of corticosteroid. Improper or delayed treatment of steroid-induced ONFH can cause hip pain, claudication, and even disability of the lower limbs.

Overall, we call for caution in the use of corticosteroids for COVID-19 and do not recommend this as a routine treatment. To prevent steroidinduced ONFH, corticosteroids should be considered only for patients undergoing septic shock, or in critical cases. 6, 7 Corticosteroids should be minimised in dose and duration, and the use of multiple types should be avoided. We believe that bisphosphonates and vitamin E should be prescribed to patients who are undergoing corticosteroid treatment; anticoagulants, vasodila tors, and traditional Chinese medicine could also be considered. [8] [9] [10] Close follow-up should be conducted after discharged, with MRI as the best option for early detection of ONFH. Physical therapy and combined pharmacotherapy have been recommended for patients with early-stage steroid-induced ONFH. 11 We declare no competing interests. 

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