New York: International clinical trials published on Wednesday confirm the hope that cheap, widely available steroid drugs can help seriously ill patients survive Covid-19, the illness caused by the coronavirus.
Based on the new evidence, the World Health Organization issued new treatment guidance, strongly recommending steroids to treat severely and critically ill patients, but not to those with mild disease.
“Clearly, now steroids are the standard of care,” said Dr. Howard C. Bauchner, the editor-in-chief of JAMA, which published five papers about the treatment.The new studies include an analysis that pooled data from seven randomized clinical trials evaluating three steroids in more than 1,700 patients. The study concluded that each of the three drugs reduced the risk of death.
JAMA published that paper and three related studies, along with an editorial describing the research as an “important step forward in the treatment of patients with Covid-19.”Corticosteroids should now be the first-line treatment for critically ill patients, the authors said. The only other drug shown to be effective in seriously ill patients, and only modestly at that, is remdesivir.
Steroids like dexamethasone, hydrocortisone and methylprednisolone are often used by doctors to tamp down the body’s immune system, alleviating inflammation, swelling and pain. Many Covid-19 patients die not of the virus, but of the body’s overreaction to the infection.
In June, researchers at Oxford University discovered that dexamethasone improved survival rates in severely ill patients. Researchers had hoped that other inexpensive steroids might help these patients.
The evidence had been lacking: After the Oxford researchers made their announcement, some clinical trials of steroids were halted, as doctors were loathe to withhold what appeared to be an effective treatment from study participants.
Steroids can have harmful side effects, especially in elderly patients, who make up the majority of very ill coronavirus patients. The drugs may leave patients vulnerable to other infections, may raise blood glucose levels, and may cause confusion and delirium.
In the clinical trials, only the sickest patients were treated with steroids, and it is not certain that those who are less ill will benefit or be harmed. The optimal doses and duration of treatment also need to be identified.
But over all, the scientists said, the new studies appeared to confirm the promise of this class of drugs for patients severely ill with Covid-19.
The studies “are like the second punch of a one-two punch,” said Dr. Derek C. Angus, chair of the department of critical care medicine at the University of Pittsburgh, who co-authored one of the new studies and the analysis.
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