Many critically ill COVID-19 patients saved with steroid treatment, analysis shows
Steroids lowered the mortality rate among hospitalized coronavirus patients needing respiratory support compared to those receiving “usual” care and placebos, according to a new meta-analysis of seven international clinical trials.
In the more than 1,700 critically ill patients included in the randomized trials that spanned 12 countries on 5 continents, steroids were “clearly associated with benefit” in terms of reducing mortality risks and showed relatively consistent results in each trial, according to an editorial on the drugs and COVID-19 published Wednesday in JAMA Network.
Health experts call the treatment “an important step forward.”
“While much work remains on the exact details of implementation into clinical practice, the consistent findings of benefit in these studies provide definitive data that corticosteroids should be first-line treatment for critically ill patients with COVID-19,” the editorial said.
‘The COVID-19 pandemic has brought fear and a sea of change to the world. These studies provide evidence and some hope that an effective, inexpensive, and safe treatment has been identified. Hope because corticosteroids provide a widely available treatment for the most severely ill patients with COVID-19.”
The World Health Organization also released “living guidance” Wednesday on steroids and the coronavirus. The group said they recommend treating severe and critical COVID-19 patients with steroids over none at all, but those with a non-severe infection should not receive the drugs because data shows they “would not likely derive benefit and may derive harm.”
This is because steroids are usually given to patients to minimize activity in the immune system by reducing inflammation. It is this inflammation that attacks the whole body from an overworked immune system that leads to many deaths among coronavirus patients. If given to people with mild infections, steroids could block their immune system from fighting the virus as much as it needs to.
What did the analysis find?
A total of 1,703 coronavirus patients in Australia, Brazil, France, New Zealand and the U.S, among others, were recruited to test dexamethasone, hydrocortisone or methylprednisolone while in the hospital between February and June, according to the study; 678 patients received the steroids while 1,025 received usual care or a placebo.
There were 222 deaths among patients given steroids and 425 deaths among those who didn’t receive them, corresponding to “an absolute mortality risk of 32% with corticosteroids compared with an assumed mortality risk of 40% with usual care or placebo,” the researchers concluded in their study published Wednesday in JAMA Network.
And among six trials that reported “serious adverse events,” more occurred within the groups on placebos than those on steroids.
What’s more, the steroids proved beneficial for patients whether they were mechanically ventilated or receiving oxygen without use of a machine, according to the study. The odds for mortality risk also “appeared similar for older and younger individuals, men and women, and for longer and shorter durations of symptoms before randomization.”
However, the benefits of lower mortality were less pronounced for patients on mechanical ventilation. The researchers who wrote the editorial said the “imprecision of this result is high” because few patients who did not need a machine to breathe were recruited in the trials.
Limitations in the clinical trials
Other limitations in the meta-analysis include an inconsistent reporting of adverse events across the trials, the focus on adults and not children, and the fact that the trials were “mainly conducted in high-income settings,” the researchers noted.
The seven trials did not assess optimal dosages and duration of treatment, but the researchers said there was no evidence that higher doses of steroids were associated with greater benefit in terms of decreased mortality risks.
“Overall, the meta-analysis indicates that administration of steroids is clearly associated with benefit among critically ill patients with COVID-19, although the exact threshold at which an individual patient should be prescribed corticosteroids remains unclear,” the editorial read.
This story was originally published September 2, 2020 at 11:12 AM with the headline "Many critically ill COVID-19 patients saved with steroid treatment, analysis shows."
