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Steroids cut the risk of death in critically-ill coronavirus patients by a fifth (20%), research suggests.
Hopes were first raised in June when scientists from the University of Oxford found the low-cost steroid dexamethasone reduced the odds of fatality by one-third in patients on ventilation.
A review of seven studies – co-ordinated by the World Health Organization (WHO) – has since found treatment with the steroids dexamethasone, hydrocortisone or methylprednisolone reduced the risk of death by an estimated 20%.
This is equivalent to around 68% of patients surviving after steroid treatment, compared to approximately 60% without the therapy.
Steroids are anti-inflammatory drugs that are thought to dampen swelling in the lungs of seriously ill coronavirus patients who require oxygen to support their breathing.
Off the back of the results – which have been hailed a “tour de force” – the WHO will issue new guidelines to include steroids in the treatment of critically-ill individuals.
The NHS will reportedly “take immediate action” to ensure patients who could benefit from steroids receive them, “adding a further weapon in the armoury in the worldwide fight against COVID-19 [the disease caused by the coronavirus]”.
‘Clear evidence of how we can tackle this disease’
“At the beginning of the year at times it felt almost hopeless, knowing we had no specific treatments,” said Professor Anthony Gordon, lead author of the Imperial College London study; one of the seven in the review.
“It was a very worrying time. Yet less than six months later, we’ve found clear, reliable evidence in high quality clinical trials of how we can tackle this devastating disease.”
At the start of the outbreak, patients requiring hospitalisation were given supportive care, like ventilation, while their immune system worked to fight off the infection naturally.
In an effort to combat the pandemic, scientists from across five continents shared their pre-published results among themselves in a “groundbreaking collaboration”.
The study review was made up of seven trials – three of which are published in the journal JAMA – with more than 1,700 critically-ill patients between them.
One of the studies was the University of Oxford’s Recovery trial, which revealed dexamethasone’s potential in preliminary results released in June.
“Pooling data across seven trials conducted over a period of only three months highlights the willingness of researchers around the world to share data in a new research model that can bring reliable evidence rapidly to improve the care of patients with COVID-19,” said Professor John Marshall, author of the University of Toronto study.
Results ‘a tour de force’
Combining the seven trials revealed receiving dexamethasone, hydrocortisone or methylprednisolone reduced the risk of death by an estimated 20%.
The benefit appeared greatest among patients who were not so sick they needed medicine to support their blood pressure, however, this was inconclusive.
The patients improved on the steroids regardless of whether they were on ventilation at the start of the treatment.
Age, sex or duration of ill health did not appear to influence whether a patient benefitted. This is despite statistics flagging age and being male as a risk factor for complications.
When looking at the studies individually, dexamethasone and hydrocortisone were found to be similarly effective.
Scientists from Imperial College London analysed hydrocortisone, with some patients receiving 50mg of the drug four times a day for a week, others only being given the therapy if their blood pressure dropped and the third group having no hydrocortisone.
The team found the 50mg regimen led to a 93% chance of a “better outcome”, defined as greater odds of survival and less need for organ support, compared to no hydrocortisone.
When given only once blood pressure was low, the patients had an 80% chance of a better outcome.
Methylprednisolone appeared to have a similar effect, however, too few patients received it to be sure.
“The analysis reported in this paper is a tour de force,” said Professor Stephen Evans from the London School of Hygiene & Tropical Medicine.
“It is always good to have confirmatory evidence after encouraging results as were seen with dexamethasone in the Recovery trial and this analysis increases confidence that it has a really worthwhile role in critically-ill patients with COVID-19.”
The preliminary Recovery results found dexamethasone did not benefit milder patients, like those requiring hospital care but not oxygen. This finding was replicated in the seven study review.
‘Further weapon in worldwide fight against COVID-19’
Early in the outbreak, officials suggested a vaccine or effective drug could be a route back to life as we once knew it.
Although the study review produced “very impressive” results, preventative measures like face coverings and social distancing “remain as important as ever”, according to the team behind it.
“Steroids are not a cure, but they help improve outcomes,” said Professor Gordon.
“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.”
When it comes to the ongoing issue of immunisation, Professor Martin Landray from the University of Oxford said: “Vaccines and treatments are both required, and are not to be seen as either/or.
“Vaccines prevent disease, and allow people to re-engage with social and economic activities.
“Even with vaccines, people will get severe disease from time to time.
“Face masks and social distancing remain as important as ever. For patients who despite that end up sick, requiring oxygen or ventilation, these drugs work.”
Since June, dexamethasone has been used in hospitals throughout the UK to reduce the risk of death among patients on ventilators or oxygen.
“Just as we did with dexamethasone, the NHS will now take immediate action to ensure that patients who could benefit from treatment with hydrocortisone do so, adding a further weapon in the armoury in the worldwide fight against COVID-19,” said Sir Simon Stevens, CEO of the NHS.