In yet another study doing a meta-analysis about treating critically ill COVID-19 patients, the use of cheap and commonly available corticosteroids have been found to be beneficial. In fact, this drug could prove a life-saver. The study, published in JAMA (Journal of American Medical Association), included data from seven randomised clinical trials, found that administering steroids can reduce the risk of death among critical patients by one-third.
In June, a randomised and controlled clinical study conducted in the United Kingdom found that the readily available steroid drug, Dexamethasone, could be a game-changer in treating critically ill COVID-19 patients. The utility of dexamethasone came out of the RECOVERY (Randomised Evaluation of COVID-19 therapy) project.
The World Health Organisation or WHO has updated its treatment guidelines for corticosteroids on Wednesday saying that those patients who are critically ill should receive the drug for seven to 10 days as a new standard of care.
The JAMA study did the meta-analysis on seven randomised trials that included 1,703 patients. A total of 222 out of 678 patients died when corticosteroids were used (approximately 32%). While among the 1,025 patients that were given usual care or placebo, 425 died (approximately 41%). The study concludes that systemic corticosteroids when administered among the critical patients, brings down the 28-day all-cause mortality.
WHAT ARE CORTICOSTEROIDS?
To understand corticosteroids, one needs to know what a steroid is. It is a man-made chemical that resembles a hormone in its structure and function. Corticosteroids are more specialised. It is a chemical that resembles cortisol, the hormone produced by the adrenal glands.
Corticosteroids can function in a similar fashion as cortisol. They behave like transcription factor, which is a protein that binds to a specific location in the DNA and by doing so can influence the expression of a gene—either suppressing or expressing it.
Dexamethasone is widely used in various kinds of inflammatory diseases, such as arthritis, allergic reactions, skin and eye conditions.
CONCERNS ABOUT CORTICOSTEROIDS
In previous studies on SARS (severe acute respiratory syndrome) and MERS (Middle East Respiratory Syndrome), the use of corticosteroids among critical patients did not give very conclusive results. This pertains to the fact that corticosteroids can suppress the immune response, whereas an active immune system is required to fight off the virus.
However, the randomised studies done till now offer good results in using corticosteroids among critical COVID-19 patients. Dr Todd Rice, a critical care physician and an associate professor of medicine at the University of Michigan, said that the new analysis should dispel any remaining doubt on administering steroids to critical COVI-19 patients.
Todd, along with Hallie Prescott, wrote an editorial, also published in JAMA, where they mentioned that concerns about hobbling the immune system do not seem to big in the case of COVID-19. The benefit of corticosteroid outweighs the harm it could pose, but the exact dose that can be prescribed to a patient still remains unclear, the editorial adds.