Steroids Could Lower Death Rates Among COVID-19 Patients

Hospitals struggled to keep up with the number of incoming COVID-19 patients this past spring. While doctors were able to rely on established treatment guidelines for other illnesses, little was known about treatment options for COVID-19. But through trial and error, researchers have been able to determine what treatments are effective.

According to a series of clinical trial results published this week by The Journal of the American Medical Association, cheap and widely available steroid drugs could save the lives of severely ill COVID-19 patients. The meta-analysis followed seven randomized trials and evaluated the effects of three steroids—dexamethasone, hydrocortisone, and methylprednisolone—in more than 1,700 patients. The study revealed that each of the three steroids reduced the risk of death.

Steroids are often used by doctors to reduce inflammation; they were seen as possible COVID-19 treatments because many patients die not from the virus itself but from the body’s overreaction to the disease. Corticosteroids reduce inflammation by suppressing inflammatory genes in a cell’s nucleus and increasing expression of the gene that encodes Annexin A1, a protein that limits inflammation.

Researchers from Oxford University found in June that dexamethasone reduced mortality rates among critically ill patients. Specifically, it reduced the risk of death for patients on ventilators and those who need oxygen by 12 percent and five percent, respectively.

A study in France analyzed the effects of low doses of hydrocortisone on 149 COVID-19 patients; those who received the drug were more likely to survive, but the trial was stopped too early for the results to be significant. Another study testing hydrocortisone included 403 patients in eight countries. While the results suggest COVID-19 patients would benefit from hydrocortisone, the trial was also stopped prematurely. A small trial of 47 patients conducted by the World Health Organization (WHO) found that methylprednisolone led to a nine percent drop in deaths. The trials were terminated early under the recommendation of the Data and Safety Monitoring Board.

As a result of these promising trials, the National Institutes of Health (NIH) recommends corticosteroids, particularly dexamethasone, for patients who require ventilators or supplemental oxygen. Corticosteroids are currently the go-to medication for critically ill COVID-19 patients, beating out other treatment options such as remdesivir and convalescent plasma—the part of the blood that contains antibodies against viruses. While the Food and Drug Administration (FDA) authorized hospitals to treat all COVID-19 patients with remdesivir, the data is not as robust as it is for corticosteroids. The same issue lies with using blood plasma: while it is recommended by the FDA, the evidence supporting the treatment is weak.

Another benefit of corticosteroids is their low cost. According to Michael Rea, CEO of Rx Savings Solutions, a company that aims to provide a cost-saving solution for purchasing prescription drugs, a six to 10 day treatment of dexamethasone would cost between $10 and $13. In contrast, remdesivir, a drug that has been shown to shorten recovery times for severely ill COVID-19 patients, would cost $2,340 for just five days.

However, the use of corticosteroids can have adverse side effects, such as hyperglycemia, secondary infections, and psychiatric effects. The prolonged use of corticosteroids could also increase the risk of reactivation of inactive infections by impeding the immune system. Steroids reduce the activity of the immune system, which is the body’s defense against infection. Thus, the WHO and NIH have cautioned against using corticosteroids on mildly ill patients.

Before this treatment for COVID-19 patients becomes more widely used, additional research on steroids will help us further understand how these drugs affect the body and whether they’ll be effective in the long run. Healthcare professionals and patients should continue to follow WHO and NIH guidelines and stay informed on future updates.