Studies, WHO back steroid use in very ill COVID-19 patients

Sept. 3, 2020

JAMA published the results of three randomized controlled trials spanning 12 countries, a prospective meta-analysis, and a commentary, all but one—which had inconclusive results—supporting the use of systemic corticosteroids in critically ill COVID-19 patients, regardless of age, sex, duration of symptoms before treatment, or the need for mechanical ventilation, according to a news report from the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota.

Safe, inexpensive, and widely available, corticosteroids like dexamethasone, hydrocortisone, and methylprednisolone are believed to treat COVID-19 by reducing lung inflammation in patients who require supplemental oxygen.

The meta-analysis of the three corticosteroid trials published, plus four other such trials, showed that 28-day rates of death from any cause were lower in COVID-19 patients given corticosteroids than in those given usual care or a placebo. The study, conducted by the World Health Organization (WHO) Rapid Evidence Appraisal for COVID-19 Therapies (REACT) investigators, analyzed data from 1,703 patients enrolled in the trials.

Three trials each in the meta-analysis involved hydrocortisone and dexamethasone, and one focused on methylprednisolone.

Of 678 total patients randomly assigned to receive corticosteroids, 222 died (33 percent), compared with 425 of 1,025 patients (41 percent) who received usual care or placebo. The summary odds ratio (OR) for death was 0.64 (95 percent confidence interval [CI], 0.50 to 0.82; P < .001) among patients receiving dexamethasone versus standard care or placebo. The OR for hydrocortisone was 0.69 (95 percent CI, 0.43 to 1.12; P = .13), while it was 0.91 (95 percent CI, 0.29 to 2.87; P = .87) for methylprednisolone.

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