U.S.The study, which included seven different clinical trials conducted by the World Health Organization and an analysis published Wednesday in the American Journal of the American, found that cheap, readily available steroid drugs were used to treat hospitalized people with Covid-19. Medical Association.
Positive steroid findings – the result of a pool look at data known as meta-analysis – confirm a similar existence benefit reported in June by one, larger study. Corticosteroids are the first, and so far the only treatment shown to improve survival difficulties for critically ill patients with Covid-19.
Based on newly released data, the WHO on Wednesday unveiled new guidelines calling for corticosteroids to become the standard of care for “severe and severe” Covid-19 patients. Such patients should receive 7-10 days of treatment, the WHO panel said. But, warning against the use of steroids in patients with non-serious illness, he said, “The haphazard use of any treatment for Covid-19 will potentially quickly deplete global resources and potentially benefit patients as a life-saving treatment.” ”
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Hall Lee Prescott and Todd Rice, professors of medicine at the University of Michigan and the University of Michigan, said: “The consistent findings that benefit from this study provide accurate data that corticosteroids should be first-line treatment for critically ill patients with Covid-1. . ” , With Jam’s editorial.
Nahid Bhadelia, medical director of the Special Pathogens Unit at Boston University School of Medicine Medicine, said steroids have been widely adopted in the care of critically ill patients with Covid-1 with since the first trial results in June. “This is especially true in many resource-limited countries where I work. This meta-analysis builds more confidence in those results, he added.
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Other groups, including the National Institutes of Health and the Society of Infectious Diseases of America, have already issued similar guidelines recommending the use of steroids for the treatment of similar Covid-19 patients.
The new analysis includes data from 678 patients randomized to treatment with steroids and 1,025 patients for general care or placebo. All patients were diagnosed with Covid-19 and hospitalized. Most were on mechanical ventilation. Twenty-nine percent of the patients were women, but race breakdown was not disclosed.
After 28 days, 33% of patients with steroid treatment died, compared to 41% of patients on general care or placebo. In the meta-analysis, the difference in absolute mortality in a 34% reduction in risk of death for a given steroid – a statistically significant result.
The researchers found that the survival benefit was consistent regardless of the type of steroid administered, the dose, or whether the patients received only mechanical ventilation or supplemental oxygen.
Eleven percent of patients with steroids reported side effects compared to 23% of patients on general care or placebo. The reverse events varied in different tests, but there is no indication that in patients assigned to corticosteroids, the risk of serious adverse events is higher, except that the number of the least severe trials was one and three.
Corticosteroids do not directly attack the novel coronavirus. Instead, drugs work by weakening the patient’s immune system activity to prevent the lungs from attacking – a serious and often fatal condition, called acute respiratory distress syndrome or ARDS.
The first evidence that common steroids can improve the survival of patients with severe covid-1 came in June when British researchers conducted a large clinical trial called Recovery that the use of dexamethasone reduced mortality in patients with ventilation by 35%. % Of patients who needed oxygen but did not have air circulation.
Prior to the public announcement of the recovery trial results, physicians were reluctant to use steroids to treat critically ill Covid-19 patients due to concerns about side effects. Clinical trials involving other immunosuppressive drugs, such as IL-6 inhibitors, were also yielding disappointing results.
U.K. Patrick Valens, the government’s chief scientific adviser, speaking in June, called the re-ovulation study “tremendous news” and the benefits of dexamethasone’s existence as “a groundbreaking development in our fight against Covid-19”. But the findings also hampered efforts to confirm the results. Other randomized and controlled clinical trials investigating the use of steroids at the time were unable to register additional patients.
For that reason, the WHO (COWID-19) REACT Working Group’s Rapid Evidence Assessment proceeded to coordinate a meta-analysis of these incomplete but randomized and controlled trials. The analysis was performed in a probabilistic manner, i.e. the data and results of seven individual tests were not known in advance, but were shared with the WHO team for the first time to reduce the likelihood of bias.
Three individual clinical trials of steroids were published in JAMA on Wednesday, along with a WHO meta-analysis.
“In the midst of an epidemic, the efforts of clinical trial groups to initiate and take high-quality tests should be hailed as a significant achievement. Among the possible circumstances it is important [randomized controlled trials], ”Write Prescott and Rice in his JAMA editorial.
Bhadelia of Boston University said the WHO’s meta-analysis left some questions about steroids and Covid-19.
“It is unknown at this time what he will do after leaving the post [steroids] Previously. Most clinicians, including me, will not do this with existing data, ”he said, adding that it is also uncertain whether they will use biomarkers to guide treatment rather than just uncertainty.
One concern about steroids is that given too early during Covid-19, they impede the body’s ability to eliminate the virus, leading to poor results. But steroids can also benefit a subset of Covid-19 patients who do not yet need oxygen but early signs of their immune system indicate that they are overdriving.
“It will be interesting to know that co-administration of antivirals can help reduce viral load, whereas previous steroids work on the inflammatory component of that group,” Bhadelia said. “We also need more data around co-infection in the steroid use configuration.”
