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Current Affairs

How steroids act in Covid-19 cases

Date: 10 September 2020 Tags: Miscellaneous

Issue

Last week, the World Health Organization (WHO) issued new guidelines on the use of corticosteroids for the treatment of novel coronavirus infection.

 

Background

Corticossteroids are low-cost anti-inflammatory drugs that closely mimic cortisol, the hormone naturally produced by the adrenal glands in humans.

 

Details

  • The WHO has made two recommendations: that corticosteroid therapy be used for 7 to 10 days in patients with severe and critical Covid-19; that it not be used in patients with non-severe Covid-19.

  • Corticossteroids are commonly used in treatment for rheumatological inflammatory conditions: inflammations of muscles, inflammation of blood vessels, chronic arthritis, and lupus.

  • They are used in lung diseases, kidney inflammation, eye inflammation, and to reduce swelling associated with tumours of the brain and spine.

  • Three commonly used corticosteroids are dexamethasone, hydrocortisone, and methylprednisolone.

  • The WHO Rapid Evidence Appraisal for Covid-19 Therapies (REACT) Working Group published a meta-analysis on the association between the systemic administration of corticosteroids and mortality among critically ill patients with Covid-19.

  • Seven trials were included in the final meta-analysis, with patients having been recruited from Australia, Brazil, Canada, China, Denmark, France, Ireland, the Netherlands, New Zealand, Spain, the UK, and the US.

  • The researchers classified trials based on low and high dose: dexamethasone at low and high doses, low-dose hydrocortisone, and high-dose methylprednisolone.

  • The analysis sought to answer a key question: is the administration of corticosteroids associated with reduced 28-day mortality in critically ill patients?

  • The analysis found that corticosteroids were associated with lower mortality among critically ill patients who were and were not receiving invasive mechanical ventilation at randomization.

  • The findings of the meta-analysis are significant because it is on a relatively large number of critically ill patients with Covid-19 from geographically diverse sites.

  • Corticosteroids are currently indicated in moderate to severe Covid-19 patients. The recovery trial has used dexamethasone.