Study Links Corticosteroid Use With Long COVID Symptoms

When using corticosteroids in an acute phase, patients self-reported a greater chance of experiencing long COVID symptoms, according to a study in Respiratory Medicine.¹ However, researchers were keen to note that their findings should not go directly against the use of approved corticosteroids among patients with hypoxemic COVID-19 or respiratory failure.

“After any COVID-19 illness, no matter how serious, some people report that symptoms stay for months. This lingering illness has often been called long COVID or post-COVID-19 syndrome,” authors of an article at the Mayo Clinic said.² “In the US, some experts have defined long COVID as a long-lasting, chronic condition triggered by the virus that causes COVID-19. The medical term for this is an infection-associated chronic condition.”

This nationwide multicenter observational study in Japan, which analyzed over 1000 participants, found that systemic corticosteroid exposure was associated with a 1.71-fold increase in the odds of experiencing any long COVID symptom during a 1-year follow-up period. When researchers looked closer at symptom-specific outcomes at the 3-month mark, they discovered that corticosteroid therapy was particularly linked to neuromuscular issues, including a 2.43-fold increase in the odds of muscle weakness and a 3.34-fold increase in the odds of numbness.¹

Symptoms such as shortness of breath and joint pain also showed significant associations.

READ MORE: Same-Day COVID-19, Influenza Vaccination Does Not Increase Adverse Events

These findings suggest that steroid-induced myopathy, a known adverse effect where excess corticosteroids promote muscle fiber atrophy, may contribute to the lingering symptoms reported by survivors.

For pharmacists, the nuance of these results is critical. The study's subgroup analysis revealed that while the link to long COVID was apparent in the overall cohort, there was no clear association among patients who required oxygen therapy during their hospitalization.¹

This aligns with established clinical evidence, such as the RECOVERY (NCT04381936) trial, which demonstrated that dexamethasone significantly reduces mortality in severe cases involving supplemental oxygen or mechanical ventilation.^1,3

Pharmacists must balance these lifesaving acute-phase benefits against the potential for long-term complications, particularly in patients with milder cases where the indication for steroids may be less clear.¹

The challenge of ensuring appropriate prescribing is a global one. Research from a medical center in Vietnam underscores the impact of clinical pharmacists in this area, showing that targeted interventions, including training sessions and clinical assessments, increased the rate of appropriate corticosteroid prescriptions from 89% to 96.4%.⁴

Before these interventions, general rationality in prescribing was as low as 46.3%, often due to factors like a lack of physician awareness or experience. Through their potential in being a double-edged sword, corticosteroids can cause serious consequences, including immunosuppression and secondary fungal infections, if the dosage, timing, or discontinuation is handled incorrectly.^3,4

Frontline medical staff increasingly view pharmacists as the primary experts responsible for navigating these complexities. Qualitative interviews with health care workers in isolation wards revealed high expectations for pharmacists to participate in clinical decision-making, especially concerning drug interactions and contraindications.⁵

Providers noted that although they might miss potential side effects or metabolic interactions, pharmacists have the professional advantage to determine the safety and rationality of a dosage schedule. This expertise is particularly vital given that inappropriate use remains a major challenge, often wasting resources and leading to adverse health outcomes.^4,5

As patients transition from acute recovery to managing long COVID, the pharmacist's role shifts toward chronic care. The Mayo Clinic identifies more than 200 symptoms linked to long COVID, including extreme tiredness, brain fog, and fast heartbeats.²

Management often requires a multidisciplinary approach, involving everything from hydration plans for postural orthostatic tachycardia syndrome to counseling on both prescription and over-the-counter medications for pain and fatigue.

By integrating the latest findings on corticosteroid risks with proactive clinical interventions, pharmacists can help ensure that the treatments used to save lives during the acute phase of COVID-19 do not inadvertently diminish the long-term quality of life for survivors.

“In this observational overlap-weighted analysis, acute-phase systemic corticosteroid therapy during COVID-19 hospitalization was associated with higher odds of patient-reported long COVID symptoms during follow-up,” concluded the authors of the current study.¹ “However, these findings should not be interpreted as evidence against appropriately indicated corticosteroid therapy in patients with hypoxemic COVID-19 or respiratory failure.”

READ MORE: COVID-19 Resource Center

REFERENCES

1. Fukunaga N, Asakura T, Terai H, et al. Association between corticosteroid therapy during acute COVID-19 and long COVID symptoms: a propensity score overlap-weighted analysis. Respir Med. 2026;261:108914. https://doi.org/10.1016/j.rmed.2026.108914

2. Long COVID: lasting effects of COVID-19. Mayo Clinic. August 23, 2024. Accessed July 1, 2026. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351

3. Bahsoun A, Fakih Y, Zareef R, et al. Corticosteroids in COVID-19: pros and cons. Front Med (Lausanne). 2023 Aug 14;10:1202504. doi: 10.3389/fmed.2023.1202504.

4. My Huynh DT, Nguyen D, Duyen Vo QL, et al. Clinical pharmacists’ interventions on the appropriate prescription of corticosteroids at a medical center in Vietnam between 2022 and 2023. J Pharm Pharmacogn Res. 2024;12(4):606-614. https://doi.org/10.56499/jppres23.1929_12.4.606

5. Jia X, Zhang W, Du S, et al. What is the role of pharmacists in treating COVID-19 patients? the experiences and expectations of front line medical staff. Front Public Health. 2021 Dec 20;9:778863. doi: 10.3389/fpubh.2021.778863.