The World Health Organization (WHO) on Wednesday released updated guidance recommending the use of low-priced steroids to treat hospitalized patients with severe cases of Covid-19, based on a new analysis of seven randomized clinical trials that showed the drugs reduced the risk of death among such patients by one-third. They were randomized to systemic dexamethasone, hydrocortisone, or methylprednisolone or to receive usual care or placebo.
However, while talking about the steroids to improve survival rates in COVID-19 patients, recently researchers said in a statement that "This is equivalent to around 68 percent of (the sickest COVID-19) patients surviving after treatment with corticosteroids, compared to around 60 percent surviving in the absence of corticosteroids". For patients treated without ventilators, the benefit was even greater: People given steroids had a 23% chance of dying, compared with a 42% chance for people in a control group. Steroids are not a cure, but they help improve outcomes. Now they have it.
However, unlike in the RECOVERY trial, CoDEX showed no impact on all-cause mortality at 28 days (56.3% vs 61.5% with standard care alone, HR 0.97, 95% CI 0.72-1.31).
Dexamethasone has been in use in hospitals as a COVID-19 treatment for seriously ill patients for several months now, after the UK RECOVERY trial reported in June that the drug reduced mortality in COVID-19 patients ill enough to require mechanical ventilation.
"The studies show that we now have more than one choice of treatment for those who need it most".
Corticosteroids, then, might offer more promise.
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Professor Martin Landray, who is leading on the Recovery trial at Oxford, said steroids such as dexamethasone and hydrocortisone were readily available and cheap.
"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", he said.
These findings suggested "the benefit is a general class effect of glucocorticoids and not specific to any particular corticosteroid", the editorialists noted. A six- to 10-day treatment course of dexamethasone would likely cost most customers between $10 and $13, according to Michael Rea, the CEO of Rx Savings Solutions, which sells software created to help select less-expensive medicines.
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Still, many groups, including NIH andthe Infectious Diseases Society of America, and providers are recommending the use of steroids to treat severely ill, hospitalized Covid-19 patients-with caution. But for the most life-threatening cases, the pros appear to outweigh the cons.