Cutting the death toll from COVID-19 could be as simple as giving steroids to the most serious cases, according a new study from the World Health Organization.
“We recommend systemic corticosteroids rather than no systemic corticosteroids for the treatment of patients with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence),” the WHO said in its revised guidance on giving steroids, but cautioned “We suggest not to use corticosteroids in the treatment of patients with non-severe COVID-19.”
The WHO panel that made the recommendation said it did so because of “the moderate certainty evidence of a mortality reduction of 8.7% and 6.7% in patients with COVID-19 who are critically or severely ill.”
The WHO’s revised guidance came as other studies also indicated steroids have the potential to help patients with COVID-19.
“Clearly, now steroids are the standard of care,” said Dr. Howard C. Bauchner, the editor-in-chief of the Journal of the American Medical Association, according to The New York Times.
“I think there was some uncertainty about whether the effect was real,” said Dr. Todd Rice, an associate professor of medicine at Vanderbilt University School of Medicine. “This shows us steroids are clearly beneficial in this population and should clearly be given, unless you absolutely can’t for some reason, which needs to be a pretty rare occasion.”
“People are dying from this disease, and we want treatment that we are confident will decrease mortality and save people’s lives,” he said.
One study of the use of hydrocortisone published by the JAMA reported that “treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority, respectively, with regard to the odds of improvement in organ support–free days within 21 days.”
That study, its authors noted, was stopped after findings of a similar one were released.
Another study published in the JAMA titled “Evidence and Hope During the Pandemic,” reported that treatment with dexamethasone, hydrocortisone or methylprednisolone cut the risk of death by 20 percent.
“The studies published today show that we now have more than one choice of treatment for those who need it most,” said Professor Anthony Gordon, who led research into using hydrocortisone, according to The Express.
“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.”
“Administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality in critically ill patients with COVID-19,” the study reported as its bottom line.
The study reported that mortality risk dropped by 30 percent when steroids were used.
“Given the moderate certainty evidence of an important reduction in the risk of death, the panel concluded that all or almost all fully informed patients with severe or critical COVID-19 would choose treatment with systemic corticosteroids,” the WHO explained in updating its guidance to support using steroids in the most serious COVID-19 cases.
The documents warned that steroids are not for everyone.
“In contrast, the panel concluded that fully informed patients with non-severe COVID-19 would mostly not choose to receive this treatment given that current data indicated they would not like derive benefit and may derive harm,” the guidance said.
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