Dexamethasone and other corticosteroid drugs are effective treatments for seriously ill COVID-19 patients, according to a meta-analysis of seven randomized controlled trials including a total of more than 1,700 participants. The analysis, conducted by a team at the World Health Organization (WHO) and published yesterday (September 2) in JAMA, concluded that the drugs reduced the risk of dying within 28 days compared with standard care or placebo. The organization has issued new guidelines recommending use of the drugs in the treatment of patients with severe or critical COVID-19.
“Steroids are a cheap and readily available medication, and our analysis has confirmed that they are effective in reducing deaths amongst the people most severely affected by Covid-19,” Jonathan Sterne, a professor of medicine and epidemiology at Bristol University who helped conduct the meta-analysis, tells The Guardian. “The results were consistent across the trials and show benefit regardless of age or sex.”
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 new meta-analysis reviewed data from this and two other trials of dexamethasone, plus three trials of hydrocortisone and one small study of methylprednisolone. All three drugs are often prescribed by doctors to help dampen inflammation and other immune system responses. They had been proposed as potential COVID-19 treatments partly because patients who die from the disease often succumb to overreactive immune responses.
The WHO has cautioned that the findings do not mean that steroids should be given to all COVID-19 patients, and the organization currently recommends doctors not to prescribe the drugs to people with mild disease. One study included in the meta-analysis found that corticosteroids might even increase mortality in non-severe patients.
It’s still not clear exactly when steroids should be given to patients with worsening disease for the best outcome, Nahid Bhadelia, the medical director of the Special Pathogens Unit at the Boston University School of Medicine, tells STAT.
For patients who don’t yet require oxygen support but maybe be developing an overreactive immune response, “it would be interesting to know if co-administration of an antiviral may help reduce viral load while the earlier steroids work on the inflammatory component,” Bhadelia adds.