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Last June 16, researchers announced that they’d seen an improvement in survival at 28 days after entry into the a large, randomized controlled trial for COVID-19 trial for the sickest patients who received the drug dexamethasone.
These results, outcomes of 2,104 patients who received dexamethasone, are a logical solution to the immune system overreaction that happens in severe COVID-19 given the anti-inflammatory properties of the drug.
Not only is the drug cheap and widely available, the data showed that in ventilated patients in particular, giving the steroid reduced deaths by one-third, and patients on supplemental oxygen who received dexamethasone had a 20 percent lower mortality rate than those who did not.
In contrast, researchers reported no benefit of dexamethasone in subjects who were not in need of respiratory support.
On September 2 in JAMA (https://jamanetwork.com/journals/jama/fullarticle/2770279)
A meta-analysis of seven randomized controlled trials concludes that dexamethasone and other corticosteroids reduce 28-day mortality in seriously ill patients. The analysis, conducted by a team at the World Health Organization (WHO), including a total of more than 1,700 participants, concluded that the drugs reduced the risk of dying within 28 days compared with standard care or placebo. The meta-analysis reviewed data of dexamethasone, hydrocortisone and methylprednisolone which are known to reduce inflammation and other immune system responses.
The organization has issued new guidelines (https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1) recommending use of the drugs in the treatment of patients with severe or critical COVID-19 who often succumb to overreactive immune responses.
One study included in the meta-analysis found that corticosteroids might even increase mortality in non-severe patients. WHO recommends doctors not to prescribe corticosteroids to people with mild disease.
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