NEW DELHI: A meta-analysis of international clinical trials has confirmed that inexpensive, widely available steroid drugs can help seriously-ill survive Covid-19. Based on the new evidence, the World Health Organisation has now issued new treatment guidelines, strongly recommending steroids to treat severely and critically-ill patients, but has cautioned against its use in patients with mild disease.
In India, dexamethasone and methylprednisolone have been used since mid-May to aid seriously ill corona patients needing ICU care. This was even before the Recovery Trial by researchers from the Oxford University in June showed that dexamethasone was seen cutting down mortalities in patients in randomised control trials.
Now, the latest evidence includes an analysis that pooled data from seven randomised clinical trials evaluating three steroids in more than 1,700 patients. The study concluded that each of the three drugs reduced the risk of death. JAMA has published the paper and three related studies, along with an editorial dubbing the research as an ‘important step forward in the treatment of patients with Covid-19.’ Corticosteroids should now be the first-line treatment for critically ill patients, the authors have said in the paper.
Remdisivir, is the only other drug shown to be effective in seriously ill patients, marginally. But it has not been established yet that this drug reduces mortality and the benefit has been found only in terms of reduction in hospital stay. Steroids such as dexamethasone, hydrocortisone and methylprednisolone are used by doctors to calm down the body’s immune system, alleviating inflammation and pain.
For critically ill Covid19 patients, it’s not usually the pathogen itself but the hyperinflammatory reaction of the body against the infection that proves fatal for the patients. The new meta-analysis has shown that steroids were linked with a one-third reduction in deaths among critically ill Covid19 patients.
While dexamethasone produced a 36 per cent drop in deaths in 1,282 patients treated in three separate trials, hydrocortisone, tested in 374 patients in three trials, appeared to reduce deaths by 31 percent, and a small trial of methylprednisolone in 47 patients resulted in a 9 percent drop in deaths. The analysis was carried out by a WHO working group which has been working towards rapidly evaluating Covid 19 therapies. In the latest guidelines, the WHO has warned against unwarranted use of steriods and said, “It could deplete global supplies, depriving patients who genuinely need it.”