Steroids reduce deaths of critically ill COVID-19 patients, WHO confirms

The finding strengthens evidence that clinicians should give severely sick people the drugs

dexamethasone steroid in syringe

Steroids, including dexamethasone and hydrocortisone, reduce the chance of dying from severe cases of COVID-19, an analysis from the World Health Organization finds.

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In June, a large study in the United Kingdom suggested that the steroid dexamethasone could help reduce the risk of death for critically ill COVID-19 patients. Now, more evidence suggests that steroids are an effective weapon against the coronavirus.

Researchers from the World Health Organization combined data from seven randomized clinical trials for severely or critically ill COVID-19 patients treated with steroids versus standard care or a placebo up to June 9. The trials used the steroids hydrocortisone, dexamethasone or methylprednisolone. 

People who were on ventilators when their clinical trial started had a 30 percent chance of dying from the virus if given steroids compared with a 38 percent chance on standard care or a placebo, researchers report September 2 in JAMA. Results were even more promising for critically ill people who were not on ventilators: Those taking steroids had a 23 percent chance of death compared with a 42 percent for people taking a placebo or getting standard care. 

Results of three of the studies included in the combined analysis — one from France testing hydrocortisone, a trial of dexamethasone in Brazil and an international study of hydrocortisone — were published at the same time in JAMA. Those and other trials in the WHO analysis were stopped early because it wouldn’t have been ethical to continue and deny some sick patients steroids once the U.K. study found them effective.

Based on the results of the combined analysis, the WHO recommended on September 2 that doctors give dexamethasone or hydrocortisone to severely and critically ill COVID-19 patients, but not to people with milder illness. Giving steroids to people with moderate or mild cases might dampen the immune system too much, allowing the virus to do more damage. The U.S. National Institutes of Health have also recommended use of steroids for hospitalized people who need extra oxygen or are on ventilators.

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