Among patients hospitalized with severe SARS-CoV-2 infection, acute-phase systemic corticosteroid exposure is associated with greater odds of long COVID symptoms, according to a study.
Reports of long COVID symptoms were more common in the corticosteroid-exposed group than in the nonexposed group across the 3-month (52.2 percent vs 44.3 percent), 6-month (43.7 percent vs 38.7 percent), and 12-month (35.4 percent vs 32.1 percent) assessments. [Respir Med 2026;doi:10.1016/j.rmed.2026.108914]
The odds of long COVID symptoms during follow-up were 71-percent greater among patients in the corticosteroid-exposed group than those in the nonexposed group (odds ratio [OR], 1.71, 95 percent confidence interval [CI], 1.12–2.63; p=0.013).
In exploratory symptom-specific analyses at the 3-month follow-up, corticosteroid treatment was associated with increased odds of muscle weakness (OR, 2.43, 95 percent CI, 1.27–4.65; p=0.008), numbness (OR, 3.34, 95 percent CI, 1.19–9.40; p=0.022), dyspnoea (OR, 1.99, 95 percent CI, 1.07–3.69; p=0.030), and arthralgia (OR, 2.63, 95 percent CI, 1.04–6.66; p=0.042).
Steroid-induced myopathy
“Steroid-induced myopathy is a well-recognized adverse effect of systemic corticosteroid therapy, in which excess corticosteroid exposure promotes preferential atrophy of type II muscle fibres through increased protein breakdown and reduced protein synthesis,” the investigators noted.
The results of the symptom-specific analyses, they said, warrant consideration of steroid-induced myopathy and related neuromuscular complications as contributors to the symptoms that emerge relatively early after COVID-19 hospitalization.
“Future studies integrating objective functional assessments and mechanistic biomarkers with patient-reported outcomes are needed to clarify whether specific symptom patterns are more strongly associated with acute-phase corticosteroid exposure and whether such associations vary according to baseline risk,” the investigators said.
Appropriately indicated steroid
These findings should not be interpreted as evidence against appropriately indicated corticosteroid therapy in patients with hypoxemic COVID-19 or respiratory failure, according to the investigators.
Subgroup analysis defined by oxygen requirement showed no clear association between acute-phase corticosteroid exposure and long COVID symptoms among patients who required oxygen therapy during hospitalization.
This subgroup data “is relevant to clinical interpretation, as systemic corticosteroids are recommended in current clinical guidelines for patients with COVID-19 who require supplemental oxygen, given their established survival benefit,” the investigators said. “The result does not undermine appropriately indicated corticosteroid therapy in patients with hypoxemic COVID-19.”
The study included 1,044 adults hospitalized with laboratory-confirmed SARS-CoV-2 in Japan between 2020 and 2021. Of these patients, 373 received systemic corticosteroids during the acute phase of infection and 671 did not.
Patients in the corticosteroid-exposed group were older than those in the unexposed group (63.4 vs 53.3 years), were mostly male (75.6 percent vs 58.7 percent), had higher BMI (25.4 vs 23.8 kg/m2), and were more likely to have hypertension (46.9 percent vs 27.5 percent) and diabetes mellitus (24.6 percent vs 12.7 percent). More patients in the corticosteroid-exposed group received oxygen support on admission (low flow: 26.5 percent vs 5.1 percent; high flow: 1.6 percent vs 0.4 percent).