24th Sep 2020
24th Sep 2020
Curated by Endre Szvetnik
Recent research papers have confirmed that steroids can significantly reduce the risk of death in critically ill COVID-19 patients. The results came from several clinical trials involving licenced, immediately available drugs.
Four recent papers, among them a high-value systematic review came to the same conclusion: a group of steroid drugs can cut the risk of death by at least 20% in COVID-19 patients who were placed on breathing support. The papers report on medical trials conducted with three different licenced steroids: dexamethasone, hydrocortisone and methylprednisolone. These are currently used to treat eye inflammation, skin conditions, allergies and autoimmune conditions, including MS.
The review paper pooled results from 7 randomised controlled trials where patients received either one of the steroids or a placebo. Dexamethasone came out on top with a 36% reduction of risk of death. Hydrocortisone produced similar results, reducing the odds by 31%. In comparison, methylprednisolone achieved only an 8% reduction, however, it was tested only in one small trial.
One other paper reported that patients who received the steroid treatment managed to spend more time off ventilation than those on standard care (6.6 days as opposed to 4 days). Another confirmed that critically ill patients could expect a 93% chance of a better outcome – meaning higher odds of survival and less need for organ support – if they received a fixed steroid dose.
Because they clarify that not just one drug but a whole class of steroids have beneficial effects for critically ill COVID-19 patients. These drugs can be used straight away because they are already licenced and available. It also means a smaller likelihood of supply shortages. The drugs are also cheap: a dexamethasone treatment can cost less than $6.50 per person. Additionally, the research revealed that the steroids worked in small doses which can also help keep costs down.
They are not to be confused with muscle boosting anabolic steroids used by bodybuilders or sportspeople who break doping rules. Steroids are mostly used to treat illnesses where the immune system overreacts and attacks the body. This can happen in severe COVID-19 cases in the form of the damaging 'cytokine storm'.
Yes, as they affect the genes that produce cytokines, which are signalling proteins for the immune system. Steroids reduce cytokine levels and by this lower inflammation. However, suppressing inflammation - a natural protection mechanism of the body – also weakens the immune system. So, although steroids can save lives, they need to be administered with caution, for example, to prevent COVID-19 patients from catching secondary bacterial infections.
Here is the current state of science on a Sparrho pinboard.
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