Scientists report that steroids can save lives in Covid-19 patients

An international clinical trial, published Wednesday, hopes that cheap and widely available steroid drugs will help critically ill patients survive the disease that is caused by the coronavirus, Covid-19. Confirming.

World Health Organization based on new evidence Issue new treatment guidance, Steroids are strongly recommended for the treatment of severe and severe patients, but not for patients with mild illness.

“Obviously, steroids are now the standard of care,” said Dr. Howard C. Bowner, editor-in-chief of JAMA, who published five papers on treatment.

New research includes Pooled data from 7 randomized clinical trials Three steroids are being evaluated in over 1,700 patients. The study concludes that each of the three drugs reduced the risk of death.

JAMA published this paper and three related studies, as well as an editorial describing the study as “a significant step in the treatment of Covid-19 patients”.

Corticosteroids should now be the first-line treatment of critically ill patients, the authors said. The only other drug that has been shown to be effective in critically ill patients is lemdecivir.

Doctors use steroids such as dexamethasone, hydrocortisone, and methylprednisolone to suppress the body’s immune system and relieve inflammation, swelling, and pain. Many Covid-19 patients die from the body’s overreaction to infection, not the virus.

In June, researchers at Oxford University discovered that dexamethasone improves survival in critically ill patients. Researchers wanted other cheap steroids to help these patients.

Lack of evidence: Several steroid clinical trials were discontinued after the Oxford researchers made a presentation.

Steroids can cause harmful side effects, especially in older patients, who make up the majority of highly sick coronavirus patients. The drug can leave patients vulnerable to other infections, raise blood sugar levels, and cause confusion and delirium.

In clinical trials, only the most ill patients were treated with steroids, and it is uncertain whether less ill people would benefit or be harmed. The optimal dose and duration of treatment should also be identified.

But overall, the scientists said the new study appeared to support the promise of this class of drugs for critically ill patients with Covid-19.

The study “is like the second punch of a one-two punch,” said one of the new studies.

“When I saw the results, I had a big smile on my face,” Dr. Angus added. “This is the case for “questions asked, questions answered”, which is very rare. “

Analysis of pooled data found that steroids were associated with a one-third reduction in deaths in severely ill Covid-19 patients. Dexamethasone reduced mortality by 36% in 1,282 patients treated in three separate trials.

Hydrocortisone, tested in 374 patients in three trials, appears to reduce mortality by 31%, and a small study of methylprednisolone in 47 patients reduced mortality by 9% .. The analysis was performed by a WHO working group working in an effort to quickly evaluate Covid-19 therapy.

Taken together, the new study will strengthen confidence in the use of steroids and address any hesitation that remains on the part of some doctors, an associate professor of medicine and paramedics at Vanderbilt University School of Medicine. Said Dr. Todd Rice.

In the new guidance, the WHO warned against using steroids indiscriminately, emphasizing that non-severe patients are less likely to benefit and may suffer side effects. Improper use can deplete the global supply and deprive patients who really need the drug.

Health organizations have conducted a meta-analysis and Oxford University has partnered with researchers from seven clinical trials to provide additional evidence in the fastest way possible, with WHO officials giving preliminary reports of findings. Shortly after the announcement, we started work on guidance in June. The above.

They characterized the quality of evidence supporting steroid treatment in critically ill patients as one of “medium certainty”.

Another study, published Wednesday, included a Brazilian trial of 299 patients with acute respiratory distress syndrome comparing dexamethasone treatment with usual care. Steroids significantly improved results and increased patient days Alive and without mechanical ventilation..

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Another study in France Evaluated low dose of another steroid, hydrocortisone, 148 patients. Patients receiving the drug were more likely to survive, but the results were not statistically significant because the study was stopped early.

The third study tested a variety of hydrocortisone therapies in 400 severe Covid-19 patients in eight countries. That was stopped prematurely, but researchers Concluded that there was a strong possibility Treatment improved outcomes.

When the Oxford results were announced in June, doctors around the world started using dexamethasone. “I think there was uncertainty as to whether or not the impact was actually there,” said Dr. Rice, who co-authored the editorial accompanying the new JAMA paper.

“This shows that steroids are clearly beneficial to this population and need to be given explicitly unless for some reason absolutely impossible. This should be a fairly rare opportunity .”

The drug lemdecivir moderately shortens the time to recovery in severely ill Covid-19 patients, he noted, but has not been shown to reduce deaths. “People are dying of this disease. We want a cure that we are confident will reduce mortality and save people’s lives,” Dr. Rice said.