A patient-tailored approach for corticosteroid treatment in COVID-19: still not there yet

Three years after its first appearance, SARS-CoV-2 is still among the most troublesome respiratory viruses and the COVID-19 pandemic is still not under control globally [1]. A clear association between dysregulated inflammation and adverse clinical outcomes has been demonstrated in COVID-19 since the very beginning of the pandemic with the so-called “cytokine storm” advocated as the key pathogenetic mechanism in severe disease [2, 3]. The scientific community theorized the use of immunomodulating agents to control this process and, among them, systemic corticosteroids have been extensively used during the pandemic since their first evidence in reducing mortality in June 2020 [4]. International guidelines unanimously report moderate-to-strong recommendations in favour of corticosteroids for hospitalised COVID-19 patients with acute respiratory failure (ARF) based on moderate-to-high quality evidence [5–9].