Cheap steroids can save critically ill Covid patients: WHO analysis

In a significant discovery, data pooled from 121 hospitals in eight countries by clinicians and scientists have found that inexpensive, widely available steroids improve the odds that very sick Covid-19 patients will survive the illness.

The analysis was conducted by the World Health Organization (WHO) and was published on Wednesday in the Journal of the American Medical Association (JAMA).

Based on the newly-published data, the WHO has issued new treatment guidelines calling for corticosteroids to become the standard of care for patients with "severe and critical" Covid-19.

Such patients should receive 7-10 days of treatment, a WHO panel said, cautioning against the use of steroids in patients with non-severe illness, saying that "indiscriminate use of any therapy for Covid-19 would potentially rapidly deplete global resources and deprive the patients who may benefit from it most as potentially life-saving therapy."

"It is relatively rare in medicine that you find drugs where the evidence of their effectiveness in saving lives is so consistent," said lead author of the study Derek Angus, Professor and Chair at the Department of Critical Care Medicine in the University of Pittsburgh.

"This is, in many respects, the single clearest answer we`ve had so far on how to manage terribly-ill Covid-19 patients. People on ventilators or oxygen and under intensive care should definitely be given corticosteroids," Angus added.

This research suggested that steroids improve the survival of the sickest Covid-19 patients.

"At the beginning of the year, at times it felt almost hopeless, knowing that we had no specific treatments. It was a very worrying time. Yet less than six months later, we`ve found clear, reliable evidence in high quality clinical trials as to how we can tackle this devastating disease," said Professor Gordon, Chair in Anaesthesia and Critical Care at the Imperial College London.

These findings offer further evidence that corticosteroids can be an important part of Covid-19 treatment for severe patients.

Steroids are anti-inflammatory drugs, and evidence strongly suggests that they reduce the lung inflammation in patients with Covid-19 who are seriously ill and require oxygen support for their breathing difficulties.

The findings were made through the "Randomized Embedded Multifactorial Adaptive Platform-Community Acquired Pneumonia" (REMAP-CAP).

REMAP-CAP is one of seven randomised control trials to test corticosteroids for treating Covid-19 in critically-ill patients.

Between March and June, the REMAP-CAP corticosteroid trial randomised 403 adult Covid-19 patients admitted to an intensive care unit to receive the steroid hydrocortisone or no steroids at all.

The trial found 93 per cent probability that giving patients a seven-day intravenous course of hydrocortisone would result in better outcomes than not giving the steroid.
The results were consistent across age, race and sex.

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REMAP-CAP and the other corticosteroid trials did not test the drugs in patients with less severe Covid-19.

Other groups, including the National Institutes of Health (NIH) and the Infectious Diseases Society of America, have already issued similar guidelines recommending the use of steroids to treat patients with severe Covid-19.