International clinical trials published on Wednesday confirm the hope that cheap, widely available steroid drugs can help critically ill patients survive the disease caused by Covid-19, coronavirus.
Based on new evidence, the World Health Organization issued a new treatment guideline, which strongly recommended steroids for the treatment of critically ill and critically ill patients, but not those with mild disease.
“Clearly, steroids are now the standard of care,” Dr. Howard c. Bouchner, editor-in-chief of JMA, who published five papers on treatment.
The new studies include an analysis that pulls data from seven randomized clinical trials evaluating three steroids in more than 1,700 patients. The study concludes that each of the three drugs reduces the risk of death.
Jama published the paper and three related studies, calling the research “an important step forward in the treatment of Covid-19 patients.”
Corticosteroids should now be the first line treatment for critically ill patients, the authors said. The only other drug that has been shown to be effective in critically ill patients is, and mildly, remedivir.
Steroids such as dexamethasone, hydrocortisone and methylprednisolone are often used by doctors to infect the body’s immune system, relieving inflammation, swelling and pain. Many Covid-19 patients do not die from the virus, but from the body’s excesses against the infection.
In June, researchers at Oxford University found that dexamethasone improved survival rates in critically ill patients. The researchers hoped that other cheaper steroids could help these patients.
Evidence was lacking: after Oxford researchers made their announcement, some clinical trials of steroids were halted because doctors who appeared to be effective treatments by study participants were desperate to stop.
Steroids can have harmful side effects, especially in elderly patients, which makes most sick coronavirus patients. Medications can leave patients susceptible to other infections, raise blood glucose levels, and cause confusion and delirium.
In clinical trials, only the sickest patients were treated with steroids, and it is not certain that those who are less sick will benefit or suffer. The optimal dose and duration of treatment also need to be identified.
But, scientists said, new studies from Covid-19 appeared to confirm the promise of this class of drugs for critically ill patients.
The study “is like a second punch,” said Dr. John K. Snyder, president of the Department of Critical Care Medicine at the University of Pittsburgh. Derek C. Said Angus, who co-authored the new study and analysis. .
Dr. Angus added, “I had a big smile on my face when I saw the results. “This is a case, ‘a question was asked, a question was answered,’ and it’s very rare.”
Analysis of the pooled data revealed that steroids were associated with a reduction in mortality in one-third of critically ill Covid-19 patients. Dexamethasone reduced mortality by 36 percent in 1,282 patients treated in three different trials.
Hydrocortisone, tested in 374 patients in three trials, showed a 31 percent reduction in mortality, and a small trial trial of methylprednisolone in 47 patients had a 9 percent reduction in mortality. The analysis was performed by a WHO working group that is trying to quickly evaluate the Covid-19 treatment.
Together, the new studies will boost confidence in the use of steroids and reduce any delayed contractions in favor of some physicians, said Dr. A.S.
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Frequently Asked Questions
Updated September 1, 2020
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Why is it safe to spend time outside together?
- The risk of outdoor gatherings is low because the wind spreads viral drops, and sunlight can kill some viruses. University of Leicester virologist Dr. Julian W. Tang said open spaces prevent the virus from infecting and inhaling concentrated amounts, which occurs when infected people exhale in confined spaces for long periods of time. Julian W. Tang said.
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- At first, the coronavirus seemed to be primarily a respiratory illness – many patients had fevers and colds, were weak and tired, and were breathing heavily, although some did not show many symptoms. Those who looked sick had pneumonia or acute respiratory distress syndrome and received supplemental oxygen. So far, doctors have identified many more symptoms and syndromes. In April, the CDC added to the list of signs of the onset of sore throats, fevers, colds and muscle aches. Gastrointestinal discomfort such as diarrhea and ause baka have also been observed. Another telling sign of infection is that a sudden, profound decrease in one’s sense of smell and taste can occur. In some cases adolescents and young adults have developed painful red and purple lesions on their fingers and toes – nicknamed “covid toes” – but some other serious symptoms.
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Why does it help to stand six feet away from the other?
- Coronavirus is mainly spread through your mouth and nasal drops, especially when you cough or sneeze. The CDC, one of the organizations using the measure, supports the six-foot recommendation on its feet that when coughing or sneezing, most of the large drops that people emit will fall to the ground within six feet. But six feet has never been a magic number that guarantees complete protection. For example, sneezing can drop as much as six feet, according to a recent study. That’s the rule of thumb: you should be safe outside six feet, especially when the wind is blowing. But always keep the mask on whenever you think you are too far away.
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I have antibodies. Am I immune now?
- For now, that seems likely, at least for a few months. The second quarrel of Kovid-19 seems to have been a terrible reckoning of the people. But experts say that while these patients may have a course of pulling the infection, the virus takes a slow week to months after initial exposure. People infected with the coronavirus usually produce immune molecules called antibodies, which are protective proteins made in response to infection. Harvard University immunologist Dr. “These antibodies can only last two to three months in the body, which is worrying, but they are completely normal once the acute infection subsides,” said Michael Meena. It is possible to get coronavirus again, but early infection will make it possible in a short time or make people sick a second time.
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In the new guidelines, the WHO warned against haphazard use of steroids, emphasizing that patients who are not seriously ill are less likely to benefit and may have side effects. Uncontrolled use can deplete the global supply, depriving patients who truly need medicines.
The health organization began work on its guidance in June, soon after Oxford University published a preliminary report of its findings, partnering with investigators from seven clinical trials to perform a meta-analysis and provide additional evidence very quickly. Said.
They characterized the quality of the evidence in favor of steroid treatment for critically ill patients as one of “moderate certainty”.
In another study published Wednesday, there was a Brazilian trial of 299 patients with acute respiratory distress syndrome who compared dexamethasone treatment with regular care. Steroids result in significant improvement, an increase in the number of days patients live and are free from mechanical ventilation.
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A second study from France evaluated low doses of another steroid, hydrocortisone, in 148 patients. Drug recipients are more likely to survive, but the results were not statistically significant because the trial was stopped as early as possible.
The third study tested different types of hydrocortisone resins in 400 critically ill Covid-19 patients from eight countries. It was discontinued prematurely, but the researchers concluded that treatment outcomes were likely to improve.
When Xford’s results were announced in June, global physicians began using dexamethasone. “I think there was a bit of uncertainty about whether the effect was real,” said Dr. Rice, who co-authored the editorial with the new papers in JAMA.
“This shows that steroids are clearly beneficial to us in this population and should be given explicitly, unless you can do it for absolutely no reason, which needs to be a pretty rare occasion.”
He noted that the drug remedesivir shortens recovery time in critically ill Kovid-19 patients, but did not show a reduction in casualties. “People are dying from the disease, and we want treatment that we believe will reduce mortality and save lives,” he said. Rice said.
