New studies underscore benefit of corticosteroids in severe COVID-19

Four new studies provide further evidence that corticosteroid treatment can significantly improve outcomes for patients who are critically ill with COVID-19, with one meta-analysis suggesting the drugs reduce the risk of death by up to 20%.

Several trials have shown that corticosteroid treatment improves outcomes in critically ill COVID-19 patients. | GETTY IMAGES
Several trials have shown that corticosteroid treatment improves outcomes in critically ill COVID-19 patients. | GETTY IMAGES

The papers, all published in the Journal of the American Medical Association (JAMA), include findings from the REMAP-CAP study, an adaptive platform trial in patients with community-acquired pneumonia being carried out in 15 countries around the world including across 143 hospitals in the UK. 

The REMAP-CAP findings show that, among critically ill patients with COVID-19, a seven-day course of hydrocortisone led to improved survival rates and less need for intensive care support compared with no hydrocortisone treatment.

“At the beginning of the year, it felt almost hopeless at times, knowing that we had no specific treatments. It was a worrying time,' said senior author Dr Anthony Gordon, professor of anaesthesia and critical care at Imperial College London.

'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. We now have more than one choice of steroid treatment for those who need it most.

'Steroids are not a cure, but they help improve outcomes. 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.'

Meta-analysis

Another paper, co-ordinated by the WHO and led by researchers at the University of Bristol and the NIHR’s Bristol Biomedical Research Centre, provides a meta-analysis of global steroid use across seven randomised controlled trials in 12 countries spanning five continents. The seven trials included REMAP-CAP and the UK's RECOVERY trial, which has already shown that the steroid dexamethasone is beneficial in the treatment of moderate to severe COVID-19. The meta-analysis concluded that corticosteroids can reduce the risk of death in the most ill patients by up to 20%.

The WHO has updated its guidance on the management of COVID-19 based on the results of the meta-analysis, recommending the drugs for patients with severe and critical COVID-19.

The remaining two papers, by teams working in France and Brazil, also report research supporting the use of steroids in critically ill patients with COVID-19.

'These findings offer further evidence that corticosteroids can be an important part of COVID-19 treatment for severe patients,' said Professor Jonathan Van-Tam, deputy chief medical officer.

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