<![CDATA[Systemic corticosteroids are an important immunomodulatory therapy for severe and critical coronavirus disease 2019 (COVID-19). Their anti-inflammatory effects may reduce excessive immune activation and pulmonary injury, although immunosuppression may impair antiviral responses and delay viral clearance. This review summarizes the role of corticosteroids in the management of COVID-19, focusing on mechanisms, clinical efficacy, indications, dosing, safety, and their use with other immunomodulatory therapies. Evidence from randomized controlled trials and meta-analyses demonstrates that corticosteroids, particularly dexamethasone, reduce mortality in patients requiring supplemental oxygen or advanced respiratory support, whereas routine use in patients without oxygen requirements is not recommended. Dexamethasone 6 mg once daily for up to 10 days or until discharge remains the best-established regimen. Higher doses do not necessarily provide additional benefit and may increase mortality and adverse events. Dexamethasone has the strongest direct evidence, while hydrocortisone and methylprednisolone have also demonstrated potential benefits, although comparative evidence remains heterogeneous. Corticosteroids may be combined with additional immunomodulatory agents, such as tocilizumab or baricitinib, in patients with persistent inflammation and clinical deterioration despite corticosteroid therapy. Overall, corticosteroid therapy should be individualized according to disease severity, oxygen requirement, dose, and treatment duration to balance suppression of pathological inflammation against preservation of antiviral immunity.]]>
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