Steroids like hydrocortisone and dexamethasone can help seriously ill Covid19 patients survive, according to a meta-analysis of seven clinical trials published in JAMA. Steroids are anti-inflammatory drugs that reduce lung inflammation in Covid19 patients who are critically ill.
Based on this research, the WHO issued new treatment guidance and a strong recommendation for the use of these systemic corticosteroids to save lives. Previously, the WHO showed support for increasing the production of dexamethasone, a corticosteroid, after a University of Oxford clinical trial. The only drug that comes close to the steroids’ effectiveness is remdesivir, which reduces recovery time but doesn’t reduce fatalities. As of now, remdesivir is priced at slightly less than Rs. 5000 in India, in comparison to dexamethasone, which retails in India for as little as Rs.10 per 10 ml.
“The studies published today show that we now have more than one choice of treatment for those who need it most. Steroids are not a cure, but they help improve outcomes. Having a choice of different types of steroids, all of which seem to improve patient recovery, is great as it helps ease the problem of drug supply issues,” Professor Anthony Gordon, co-author of the study and leader of the hydrocortisone clinical trials from Imperial College London, said in a statement.
Seven randomized clinical trials comprising around 1700 critically ill patients with COVID-19 were conducted in 12 different countries over a span of (Feb-Jun) four months. Around 700 patients randomly received either dexamethasone, hydrocortisone, or methylprednisolone, and the other 100 received placebos/usual care. After 28 days, only 33% of the patients receiving steroids died, in comparison to 41% in the placebo/usual care group.
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Corticosteroids should now be the primary treatment for critically ill patients, the scientists say. They specify critically ill, because patients with weak to moderate Covid19 symptoms will experience no benefits, or worse, side-effects. These side-effects include a rise in blood sugar, confusion and delirium. Plus, if steroids are given too soon or given to someone with a mild infection, they are likely to suppress the body’s immune system — which is dangerous with respect to the novel coronavirus, as no one is immune to it yet. The WHO also states that unwarranted use may deplete global supplies and harm severely ill patients.
“Clearly, now steroids are the standard of care,” Dr. Howard C. Bauchner, the editor-in-chief of JAMA, told the New York Times.
