Corticosteroids Expert Views

Dr. Bruce Patterson expresses skepticism about using corticosteroids (steroids) for Long Covid treatment. He argues that steroids suppress the immune system, which could potentially create reservoirs for the virus to persist and lead to chronic symptoms. Instead, he advocates for treatments like Maraviroc and statins, which modulate the immune system without suppressing it. Patterson emphasizes that his approach targets the underlying mechanisms of Long Covid, such as inflammation and immune dysregulation, rather than broadly suppressing immune activity.

Dr. William Li, a physician and scientist, discusses the potential use of corticosteroids like prednisone and dexamethasone for treating autoimmune symptoms in Long Covid patients. He notes that dexamethasone is already approved for acute COVID treatment and suggests exploring its application for Long Covid, especially for patients with severe autoimmune symptoms. Dr. Li emphasizes the importance of trialing treatments responsibly, using medical judgment to avoid errors, and providing relief to patients who are struggling.

Professor Alex Richter, a Clinical Immunologist, discusses the challenges of treating Long Covid, particularly with corticosteroids. She highlights that while steroids are effective in suppressing immune responses, the lack of understanding about the underlying mechanisms of Long Covid makes treatment difficult. She compares the situation to other conditions like supraventricular tachycardias, where treatments are applied pragmatically without fully understanding the cause. Richter also points out the lack of evidence-based guidelines and clinical trials for Long Covid, which leaves healthcare professionals in a tough spot. This uncertainty often leads to treatments based on experience rather than solid evidence, which she finds problematic.

Dr. Stephen Griffin, a virologist, discusses the use of corticosteroids like dexamethasone in treating severe cases of COVID-19 and potentially Long Covid. He explains that in acute COVID-19, the disease transitions from being virus-driven to immune-driven, which is why treatments targeting the immune system, such as corticosteroids, are effective. For Long Covid, he suggests that the condition might involve a mix of virus-driven and immune-driven problems, making corticosteroids potentially useful. However, he emphasizes that antivirals, which suppress rather than eliminate viruses, might not be straightforward solutions for Long Covid.

Dr. Tomer Bronshtein discusses the use of corticosteroids, like dexamethasone, in treating severe COVID-19 cases. He explains that while these drugs suppress the immune system to reduce inflammation, they also weaken the body's ability to fight the virus, potentially leading to recurring infections. He contrasts this with cell therapy, which targets inflammation locally without compromising the immune system's overall function. Dr. Bronshtein highlights that corticosteroids, combined with other drugs like Actemra, have reduced mortality rates in severe COVID-19 cases from 26% to 22%. However, he emphasizes that cell therapy has shown a more significant reduction in mortality, from 23% to 6-7%, and also shortens hospital stays, reducing the risk of long-term complications like Long COVID.

Dr. Jarred Younger discusses the potential risks of using corticosteroids (glucocorticoids) for long periods, particularly in relation to their effects on microglia, which are immune cells in the brain. He explains that while short-term use of these drugs is generally safe, chronic use can lead to 'microglia priming,' a state where these cells become more sensitive and reactive to triggers, potentially worsening inflammation. This is why physicians may hesitate to prescribe corticosteroids for extended periods, as the long-term risks can outweigh the benefits.

The expert discusses various treatments for Long Covid and ME/CFS, including corticosteroids. They mention that immunomodulation, which includes treatments like corticosteroids, has been explored. However, the effectiveness of these treatments seems to vary among patients, with some showing recovery while others do not. The expert also highlights that research is ongoing to better understand which treatments work for specific patient subgroups.

Dr. Patrick McGowan explains the role of cortisol, a hormone that regulates stress response, immune function, and other physiological systems. He highlights that cortisol signaling involves both the hormone itself and its receptors on target cells. In Chronic Fatigue Syndrome (CFS), which shares similarities with Long Covid, some patients show altered responses to cortisol-like drugs and have differences in immune cell function. These changes may include elevated inflammatory proteins and decreased receptor function for cortisol. Dr. McGowan's research uses samples from the SolveCFS BioBank to study these mechanisms.

Dr. Paul Jenkins, an endocrinologist, has observed that some Long Covid patients experience a reduced cortisol response, especially in the morning when symptoms like sluggishness are often worse. He has found that administering low doses of cortisol can help these patients feel more energetic and function better throughout the day. However, he emphasizes the importance of caution, as excessive cortisol can disrupt the body's natural hormone production. Dr. Jenkins also highlights the role of other hormones, such as testosterone in men and estrogen in women, in managing symptoms like fatigue and brain fog, suggesting hormone replacement therapies when necessary.

Patrick McGowan from the University of Toronto is conducting research on how glucocorticoid signaling pathways might be altered in Chronic Fatigue Syndrome (CFS), which is relevant to Long Covid. Glucocorticoids, like cortisol, are hormones that help regulate the immune system and maintain balance between pro-inflammatory and anti-inflammatory responses. McGowan's study involves using blood samples from CFS patients and healthy individuals to examine how their cells respond to a synthetic cortisol called dexamethasone. He is also investigating epigenetic changes—chemical modifications to DNA—that could explain disruptions in glucocorticoid signaling. This research could provide insights into potential treatment targets for CFS and related conditions like Long Covid.