Alert Patients Taking Glucocorticoids That They Face Enhanced COVID-19 Risks

The Endocrine Society is warning about double-barreled risks of COVID19 for patients who routinely take glucocorticoids – both more susceptibility and higher likelihood of severe response. Find out what endocrinologists recommend for these patients and also for the clinicians who treat them in case of infection.

BOSTON – Pharmacists might want to alert patients on steroids that they are at high risk if infected with the COVID-19 virus and should be especially careful to take precautions.

A new editorial published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism warns that patients who routinely use glucocorticoids for conditions such as asthma, allergies and arthritis might be unable to mount a normal stress response to infection.

As pharmacists well know, glucocorticoids are used to treat a variety of inflammatory conditions and administered by many different routes, including tablets, topical creams and inhaled medications.

The editorial cautions that patients taking those medications could both be more susceptible to COVID-19 because of a suppressed immune system and, once infected, more likely to experience severe disease because their steroid response is suppressed.

“Currently there is little evidence to guide us on when to intervene in terms of duration of prior corticosteroid exposure or on the impact of dose, either at a higher dose where supplemental steroid cover may not be necessary or a lower dose where adrenal suppression may not be as prevalent,” the Brigham and Women’s Hospital-led authors write. “In the interim, it seems logical, if not essential, that we identify all patients taking corticosteroids for whatever reason as high risk. We know from the published reports to date that these patients will be overrepresented in those at greatest risk of dying from COVID-19—the elderly and those with co-morbidities that include diabetes, hypertension, and chronic inflammatory disease.”

The endocrinology group points out that Injectable supplemental glucocorticoid therapy can be used in cases of severe response and reverse the risk of potentially fatal adrenal failure. It strongly urges that physicians treating COVID-19 considering using it in every case.

 “The intent here is to ensure that no patient with a history of prior exposure to chronic glucocorticoid therapy (>3 months) by whatever route should die without consideration for parenteral glucocorticoid therapy,” according to the editorial. “As a community, we will be key to ensuring recognition, management, and implementation of these important measures.”

The group also urges patients with known primary adrenal insufficiency, also known as Addison's disease, and secondary adrenal insufficiency occurring in hypopituitarism, to take extra precautions. “If patients develop symptoms such as a dry continuous cough and fever, they should double their oral glucocorticoid dose immediately and continue doing so until the fever has subsided. They, too, will require injectable glucocorticoid therapy should their condition worsen,” the Endocrine Society advises in a press release.

"In our professional lives, we have not witnessed a healthcare crisis of this magnitude and severity," the authors conclude.