Steroids cut death rates among critically ill COVID-19 patients, major study finds

• Finding comes from analysis of 7 international trials
• Spurs WHO to update advice on COVID-19 treatment
• Steroid dexamethasone already in widespread ICU use

LONDON: Treating critically ill COVID-19 patients with corticosteroid drugs reduces the risk of death by 20%, an analysis of seven international trials found on Wednesday, prompting the World Health Organisation to update its advice on treatment.

The analysis – which pooled data from separate trials of low dose hydrocortisone, dexamethasone and methylprednisolone – found that steroids improve survival rates of COVID-19 patients sick enough to be in intensive care in hospital.

“This is equivalent to around 68% of (the sickest COVID-19) patients surviving after treatment with corticosteroids, compared to around 60% surviving in the absence of corticosteroids,” the researchers said in a statement.

The WHO’s clinical care lead, Janet Diaz, said the agency had updated its advice to include a “strong recommendation” for use of steroids in patients with severe and critical COVID-19.

“The evidence shows that if you give corticosteroids …(there are) 87 fewer deaths per 1,000 patients,” she told a WHO social media live event. “Those are lives … saved.”

Jonathan Sterne, a professor of medical statistics and epidemiology at Britain’s Bristol University who worked on the analysis, said the trials – conducted by researchers in Britain, Brazil, Canada, China, France, Spain and the United States – gave a consistent message throughout, showing the drugs were beneficial in the sickest patients regardless of age or sex or how long patients had been ill.

The findings, published in the Journal of the American Medical Association, reinforce results that were hailed as a major breakthrough and announced in June, when dexamethasone became the first drug shown to be able to reduce death rates among severely sick COVID-19 patients.

Dexamethasone has been in widespread use in intensive care wards treating COVID-19 patients in some countries since then.

Martin Landray, a professor of medicine and epidemiology at the University of Oxford who worked on the dexamethasone trial that was a key part of the pooled analysis published on Wednesday, said the results mean doctors in hospitals across the world can safely switch to using the drugs to save lives.

The WHO’s updated guidance, published on its website late on Wednesday, said corticosteroids should only be used in treatment of the sickest COVID-19 patients, and not in non-severe cases, since “the treatment brought no benefits (in milder cases) and could even prove harmful”.

The UN health agency also urged countries to maintain sufficient stocks of corticosteroids, “while not maintaining excessive stocks which could deny other countries access”.

Researchers said the benefit was shown regardless of whether patients were on ventilation at the time they started treatment.

 

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