Steroids improve survival of critically ill COVID-19 patients: WHO issues new treatment guidelines

The World Health Organization (WHO) has issued new treatment guidelines suggesting steroids as the standard of care for patients with "severe and critical" COVID-19.

Inexpensive, widely available steroids could become the global standard of care for severe COVID-19 patients. Three studies have shown that these anti-inflammatory drugs can improve the survival of the sickest COVID-19 patients.

The studies published on Wednesday in the Journal of the American Medical Association (JAMA) strongly suggest that the use of steroids reduces lung inflammation in COVID-19 patients who are seriously ill and require oxygen support for their breathing difficulties.

After analyzing the newly-published data, the World Health Organization (WHO) has issued new treatment guidelines suggesting steroids as the standard of care for patients with "severe and critical" COVID-19.

However, the organisation has cautioned against the use of steroids in patients with non-severe illness. This is because the WHO feels that indiscriminate use of any therapy for Covid-19 would rapidly deplete global resources and deprive the patients who may benefit from it most as potentially life-saving therapy.

Similar guidelines recommending the use of steroids to treat patients with severe Covid-19 have already been issued by the health agencies, including the National Institutes of Health (NIH) and the Infectious Diseases Society of America.

Steroid hydrocortisone improves chances of recovery

One study found that treating COVID-19 patients who were receiving intensive care with a regular fixed dose of the steroid hydrocortisone (50mg hydrocortisone four times a day) for seven days improved their chance of recovery. They had a 93% chance of a better outcome (greater chance of survival and less need for organ support) than those not using hydrocortisone. The study included 403 patients who were treated at 88 hospitals including Imperial College Healthcare NHS Trust Hospitals in the UK. They were enrolled between March and June 2020.

The study was conducted by Professor Anthony Gordon from Imperial College London along with collaborators from the Intensive Care National Audit & Research Centre. It was funded by the National Institute for Health Research and supported by the NIHR Imperial Biomedical Research Centre.

Steroids are not a cure, but they can help improve outcomes, noted Professor Gordon. All steroids seem to improve patient recovery, which is great as it can ease the problem of drug supply issues, he added.

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

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.

Treatment with dexamethasone shows a similar result

A different study, called the RECOVERY trial, showed that another type of steroid, called dexamethasone, helped improve the recovery of patients with COVID-19. The first results from the study were published in early June.

Results of two other clinical trials, published in JAMA, have also evidenced the benefits of steroids as a treatment for the severely ill COVID-19 patients. This journal edition features an overall analysis of the three independent studies conducted by the World Health Organization (WHO), plus data from the original RECOVERY trial and three other smaller trials. All these studies support that a range of steroids - all safe, cheap and readily available - can improve the outcomes of patients with severe Covid-19.

With inputs from agencies