Corticosteroids confirmed to help severely ill coronavirus patients

The confirmation comes from a new meta-analysis of pooled results from seven separate studies, which found that steroids reduce the risk of death in the first month by about one-third compared to placebo treatment or usual care alone in seriously ill patients who need extra oxygen.
 
Corticosteroids have been found to reduce the inflammation which sometimes develops in coronavirus patients as the immune system overreacts to fight the infection.
 
The study, published in JAMA Network, follows previous results from the RECOVERY trial which indicated dexamethasone could be used to treat severely ill patients, and has prompted the World Health Organization (WHO) to publish guidance on the use of corticosteroids in patients with COVID-19.
 
Australia’s National COVID-19 Clinical Evidence Taskforce is also currently reviewing research on corticosteroids, having previously given the green light to dexamethasone use.
 
However, while the RECOVERY trial only showed dexamethasone could be safely used to treat severe coronavirus cases, the latest research expands on the number of options clinicians have available.
 
Dr Anthony Gordon of Imperial College London said the result is ‘a huge step forward,’ but cautioned ‘as impressive as these results are, it’s not a cure’.
 
‘We now have more than one choice of treatment for those who need it most,’ he said. 
 
‘Having a choice of different types of steroids, all of which seem to improve patient recovery, is great as it helps ease the problem of drug supply issue.’
 
Included in the meta-analysis was a Monash University-led global study, which showed intravenous use of hydrocortisone, another corticosteroid, improves recovery and survival for critically ill COVID-19 patients.
 
The trial involved 384 adult participants, and researchers found a 93% probability that administration of hydrocortisone improved recovery and survival. These findings also form part of the WHO’s clinical practice guidelines for the treatment of critically ill patients with COVID-19.
 
‘Our results suggest that the treatment effect of hydrocortisone is similar to that achieved with dexamethasone. This is not an additional treatment, but it is an alternative that is also effective,’ Professor Steve Webb from Monash University’s School of Public Health and Preventive Medicine said.
 
‘The result will also help relieve pressure on supply of dexamethasone.’
 
However, despite the success of corticosteroids in severely ill patients, the WHO has made a conditional recommendation to not use corticosteroids in the treatment of patients with non-severe COVID-19.
 
The recommendation is important for GPs, who are providing care for the majority of Victoria’s 4000 active coronavirus cases in the community.
 
‘The panel made its recommendation on the basis of low certainty evidence suggesting a potential increase of 3.9% in 28-day mortality among patients with COVID-19 who are not severely ill,’ the WHO’s guidance states.
 
‘The certainty of the evidence for this specific subgroup was downgraded due to serious imprecision [ie the evidence does not allow to rule out a mortality reduction] and risk of bias due to lack of blinding.
 
‘In making a conditional recommendation against the indiscriminate use of systemic corticosteroids, the panel inferred that most fully informed individuals with non-severe illness would not want to receive systemic corticosteroids, but many could want to consider this intervention through shared decision-making with their treating physician.’
 
Log in below to join the conversation.

coronavirus corticosteroids COVID-19 dexamethasone hydrocortisone