One study, published in the medical journal JAMA, examined several randomized trials involving more than 1,700 patients. Patients who received the steroids were more likely to survive, and there was no sign of an increased risk of serious of adverse events among those who received the drugs.
Among 678 patients treated with steroids, 32.7% died. Among 1,025 patients who received usual care or a placebo, 41.5% died.
“The bottom line is that these are the sickest patients who are being treated with corticosteroids in these trials and mortality is very high, it’s about 40% in the absence of treatment with corticosteroids,” said Jonathan A. C. Sterne of the University of Bristol, an author of one of the papers published Wednesday. “The treatment with corticosteroids reduces mortality of 40% to 32%, that’s a 20% relative reduction, or if you like to a better way to think about it, an easier way to think about, it is that out of every hundred patients treated with corticosteroids, eight additional patients do not die.”
These results suggest steroids should be part of standard care for critically ill Covid-19 patients, researchers wrote.
“These studies provide evidence and some hope that an effective, inexpensive, and safe treatment has been identified,” Dr. Hallie Prescott of the University of Michigan and Dr. Todd Rice of Vanderbilt University wrote in an accompanying editorial.
The new analysis confirms preliminary results previously shared by researchers from the UK-based Recovery trial; results from that trial are included in the new analysis. In June, those researchers said a low-dose regimen of dexamethasone for 10 days was found to reduce the risk of death by a third among hospitalized patients requiring ventilation in the trial.
WHO recommends Covid-19 treatment
Following the publication of the new research, the World Health Organization on Wednesday recommended the use of corticosteroids in patients with severe and critical Covid-19.
It does not recommend using these steroids in patients with non-severe Covid-19, and said this was an area where further research was needed.
Other areas that need more research include the long-term effects of corticosteroids on deaths and outcomes for Covid-19 survivors and how the drugs work with other therapies.
WHO noted the steroids are listed in its list of essential medicines that are “readily available globally at low cost.”
WHO had long known it wanted to study corticosteroids, Dr. Janet Diaz of WHO’s health emergencies programme said during a JAMA event about the research on Wednesday. They’re widely available and they knew people would use them.
Luckily, she said, many investigators had started studying these therapeutics, and they saw “this fantastic opportunity” to bring the investigators together for the meta-analysis.
‘A backbone for treatment of Covid’
The publications in JAMA are the strongest evidence available that corticosteroids can help patients with Covid, according to Dr. Michelle Gong, chief of critical care medicine and chief of pulmonary medicine at Montefiore Medical Center.
Gong said that she thinks most places moved toward using corticosteroids in Covid-19 patients — especially the sickest patients — after the Recovery trial announcement in June, but the publications in JAMA have “consolidated that further.”
Covid-19 patients who came into hospitals could always be treated with corticosteroids. But for those who didn’t have conditions that would typically be treated with the steroids, there was a question of how much they benefited. The new data show that even patients without conditions that would typically be treated with corticosteroids could benefit from them.
“This gives us a good foundation of evidence for all of us to use corticosteroids as a backbone for treatment of Covid,” she said, calling the cooperation around the research was a “truly remarkable international effort.”
Still, it doesn’t mean all the questions have been answered.
It’s not yet clear exactly which types of patients get the most or least benefit or what the right dose and duration should be.