The World Health Organization just endorsed cheap, widely available steroids as a lifesaving COVID-19 treatment
In the ongoing search for ways to combat COVID-19, doctors seem to have discovered a promising treatment. As if that news wasn’t hopeful enough, here’s another fortuitous fact: The treatment is both widely available and cheap. On Wednesday, citing evidence from newly published trials and a meta-analysis, the World Health Organization (WHO) endorsed corticosteroid drugs as an effective option for patients hospitalized with serious or critical cases of the novel coronavirus.
WHO based its updated recommendations on two meta-analyses, which pooled data from eight randomized trials (totaling 7,184 participants) of systemic corticosteroids for COVID-19. The organization also referred to two other meta-analyses on the subject that were published earlier this summer.
🔥🔥New RCT supporting dexamethasone in COVID19-associated ARDS🔥🔥
Higher dose dexamethasone (20 mg/d x5 –> 10 mg/dx5) resulted in a significant increase in the number of days alive & free of mechanical ventilation over 28 days vs stand care alonehttps://t.co/Oqof7mIZz8 pic.twitter.com/PHknDoa5v0
— Ilan Schwartz MD PhD (@GermHunterMD) September 2, 2020
The compelling findings? Corticosteroids such as hydrocortisone and dexamethasone reduce deaths in critically ill COVID-19 patients by up to one-third. Among the family of anti-inflammatory drugs, dexamethasone proved most effective, resulting in a 36 percent drop in deaths among nearly 1,300 patients treated in three separate trials. “Corticosteroids have received worldwide attention as a potentially effective treatment for COVID-19,” WHO’s new guidelines explain, noting this family of drugs is included in WHO’s “model list of essential medicines, readily available globally at a low cost.”
Accordingly, WHO strongly recommends systemic (i.e. intravenous or oral) corticosteroid therapy for 7 to 10 days in patients with severe and critical COVID-19.
Replication is fundamental for all work in science, no less for the results of clinical trials. That's why it's good to see the survival benefit of dexamethasone for severe #COVID19 replicated by a @WHO meta-analysis of 7 corticosteroid trials today https://t.co/ejolZfsJUl pic.twitter.com/Q2Ycb1QirL
— Eric Topol (@EricTopol) September 2, 2020
Wrote Jonathan Sterne, an author of one meta-analysis and expert in medical statistics, “Corticosteroids are the only treatment that has been conclusively demonstrated to reduce mortality in patients with COVID-19. The results strengthen the evidence that doctors should treat critically ill COVID-19 patients with corticosteroids, unless there is a strong reason not to do so based on the circumstances of the individual patients.”
Which brings us to the major caveat of WHO’s new guidelines. “In contrast, systemic corticosteroids may increase the risk of death when administered to patients with non-severe COVID-19,” the organization cautions, although careful to point out that those findings are limited to one study. Still, WHO conditionally recommends against using corticosteroid therapy in non-critical patients with the novel coronavirus.
As of Sept. 2 at 10:31 a.m. ET, @NBCNews has confirmed 6,100,902 COVID-19 cases in the US and 185,917 reported deaths.
— NBC News (@NBCNews) September 2, 2020
It also merits mentioning that all three of the trials published on Wednesday in the Journal of the American Medical Association halted after results published in June initially suggested dexamethasone as a potentially life-saving treatment. This means the steroid trials didn’t enroll enough patients for their results to be considered statistically concrete. However, the findings were clearly significant enough to sway WHO to update their recommendations, which says a lot.
Because steroids can cause unwanted side effects, WHO experts underscore that their recommendations are not DIY — they are clinical guidelines intended for doctors.
Still, considering there are over 6 million confirmed cases and 185,917 COVID-19 deaths in the U.S. as of Wednesday, it’s nice to know there is an affordable, readily available, and potentially life-saving treatment out there.