Corticosteroids can be lifesaving for critically ill COVID-19 patients

By Angela Betsaida B. Laguipo, BSNSep 3 2020

The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread across the world with alarming speed, infecting tens of millions and bringing economic activity to a near-standstill as countries imposed tight restrictions on movement to halt the spread of the virus. As the health and human toll grows – over 26 million infected and 863,000 lives lost, the economic damage is already evident.

Many people are at a high risk of developing severe COVID-19 disease, including those who are immunocompromised, those with underlying medical conditions, and the elderly, among others. High-risk people may require admission to the hospital or intensive care unit due to severe symptoms.

Now, a prospective meta-analysis of 7 randomized trials published in the journal JAMA showed that the widely available steroid drugs could help seriously ill patients survive COVID-19.

Study: Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19. Image Credit: Dotted Yeti / Shutterstock

The study

Effective therapies for patients with COVID-19 are essential to reduce the risk of severe illness and death. The team conducted the study to estimate the link between corticosteroids and the 28-day all-cause mortality.

To arrive at the findings of the study, the team pooled data from the seven randomized clinical trials that evaluated the effectiveness of corticosteroids on critically ill patients with COVID-19. The trials spanned 12 countries between February and June, and the date of the final follow-up was in July.

The study involved more than 1,700 patients, and the team has found that steroids such as dexamethasone helped reduce mortality or death in seriously ill patients.

In the results, the team has revealed that five of the trials reported mortality at 28 days, 1 trial at 21 days, and 1 trial at 30 days. Among all the patients, there were 222 deaths among the 678 patients who received corticosteroids, and 425 deaths among the 1,025 patients randomized to usual care or placebo.

“In this prospective meta-analysis of clinical trials of critically ill patients with COVID-19, administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality,” the team concluded in the study.

New WHO guidelines

The World Health Organization (WHO) also released interim guidance, strongly recommending steroids to be used as a treatment for critically ill patients.

Amid the coronavirus pandemic, corticosteroids have received worldwide attention as a potentially effective COVID-19 treatment.

In June, preliminary results of the RECOVERY trial, published in a peer-reviewed paper, were released. The finding showed that corticosteroids might help reduce the risk of death among patients with severe COVID-19.

The panel of health experts released two recommendations – the intravenous or oral corticosteroid therapy for seven to 10 days in patients with severe and critical COVID-19. Further, the WHO also recommended not to use the treatment in patients with mild to moderate symptoms.

“Given the moderate certainty evidence of an important reduction in the risk of death, the panel concluded that all or almost all fully informed patients with severe or critical COVID-19 would choose treatment with systemic corticosteroids,” the WHO said.

“Moreover, the panel believed that other perspectives (i.e., costs, equity, the feasibility of implementation), and patient values and preferences would not alter decisions. In contrast, the panel concluded that fully informed patients with non-severe COVID-19 would mostly not choose to receive this treatment given that current data indicated they would not likely derive benefit and may derive harm,” it added.

The WHO clarified that using corticosteroids in severely ill patients is recommended because if those with mild to moderate symptoms will use the drug, it will significantly deplete worldwide resources and deprive patients who may need the drug more.

Corticosteroids are a class of steroid hormones that lowers inflammation in the body as well as reduce the immune system’s activity.

The coronavirus disease is still actively spreading across the globe, with the number of cases skyrocketing. The United States remains as the nation with the highest number of cases, reaching 6.11 million, followed by Brazil, with more than 3.99 million cases. India and Russia report high case tolls, with more than 3.85 million and 1 million cases, respectively.