Steroids fight severe COVID in multiple studies

EJ Mandel
HealthDay Reporter

Wednesday, September 02 2020 (Health Day News)-Many “Gold Standards” Clinical trial Provides new hope for patients who fight severe COVID-19. A cheap, common drug known as a corticosteroid seems to reduce mortality by a third.

Release of new data on treatment with corticosteroids such as: Hydrocortisone Or dexamethasone “represents a significant step forward in the treatment of patients with COVID-19,” said Dr. Harry Prescott of the University of Michigan Ann Arbor and Dr. Todd Rice of Vanderbilt University, Nashville, TN.

They wrote an editorial accompanying four studies on corticosteroids and COVID-19. American Medical Association Journal (JAMA)..

One of the studies was “meta-analysis”, a review of data that combined the results of seven different clinical trials. These trials enrolled more than 1,700 severe COVID-19 patients treated at medical centers in 12 countries.

Researchers led by Jonathan Stern of the University of Bristol, UK, show that using corticosteroids to treat these patients reduces mortality (1 month after treatment) by about a third. it was done. This finding requires oxygen supplementation as well as patients requiring artificial respiration, ventilator, Added by the research team.

Overall, “These results from diverse clinical and geographic settings indicate that corticosteroid therapy should be a component of standard treatment for critically ill patients with COVID-19 in the absence of compelling contraindications” “Sterne’s group concluded.

Calm the storm

How can corticosteroids-which have been around for decades-to help save the lives threatened by COVID-19? As Prescott and Rice have explained, these drugs act against the runaway inflammatory response (the so-called “cytokine storm”), causing late-stage COVID-19 and overwhelming the patient’s defenses.

In addition, many patients receiving COVID-19 treatment in the intensive care unit (ICU) Acute respiratory distress syndrome (ARDS). ARDS is often found in advanced cases of pneumonia and other illnesses and can easily prove fatal.

However, Prescott and Rice said in 1967 that “corticosteroids may be of value in treating patients” with severe pneumonia and ARDS, experts said.

In June, the first convincing evidence that the drug could fight COVID-19 also emerged, with the results of a UK study of more than 6,400 patients published. The study found that the use of dexamethasone resulted in approximately one-third the mortality rate of ventilated patients and approximately one-fifth in those requiring oxygen supplementation. ..

Latest issue of JAMAResearchers working on three new clinical trials have found preliminary results showing that corticosteroids are useful for COVID-19.

One Brazilian study, which included 299 patients treated with ICU, found that the addition of dexamethasone to treatment “statistically significantly increased the number of ventilator-free days” over 28 days of treatment.” It was Two other trials-a study from France and another study involving American patients-also suggest a real improvement with the use of corticosteroids.

“The clearest answer”

The US trial included 403 COVID-19 patients treated with ICU between March and June. We found a 93% chance of getting better results when adding intravenous hydrocortisone to the treatment of patients.

“This gives hope to doctors like me who treat the most ill people’s illnesses. We are beginning to address the deadly side of this illness,” said research co-author Brian McVery. He said in a University of Pittsburgh news release. He is an associate professor of respiratory, allergy and emergency medicine in the pit.

“It’s relatively rare for a drug to find one that has very consistent evidence of life-saving efficacy,” said Derek Angus, head of the Pitt’s emergency department, chief researcher. Best regards, the most definitive answer I’ve ever had on how to manage a patient with a severe illness of COVID-19. Make sure you have a corticosteroid for anyone who is on a ventilator or oxygen and is receiving intensive care Should be administered.”

However, withdrawing corticosteroid treatment from patients in the “control” group of trials in Brazil, France, and the United States was no longer ethical, with the release of clear evidence of benefits from the British trial in June. Each of these trials was terminated early.

Meta-analysis of data from 7 different studies was However, it has been completed and shows clear benefits from corticosteroid treatment.

According to meta analysis steroid Dexamethasone was used in three trials with a total of approximately 1,300 patients and appeared to reduce the risk of death by 36% compared to standard care.

Sterne’s group reported that hydrocortisone was recruited in three trials involving a small number of patients (374) and reduced the risk of death by 31%.

Corticosteroids can have serious side effects, but a meta-analysis reveals that there is little difference in “serious adverse events” between patients who took the drug and those who did not. ..

Still, some questions remain. According to editors Prescott and Rice, these questions are: inflammation Rebound after stopping corticosteroids? … Should patients who are less severe or not hospitalized be treated with corticosteroids? …should Rem decivil Or is any other potentially effective treatment given with corticosteroids? “

However, overall, the results of the new exam published online September 2 JAMA Prescott and Rice said.

“COVID-19 Pandemic “These studies provide evidence and hope that effective, cheap and safe therapies have been identified.”