Steroids cut death rates among critically ill COVID-19 patients, studies suggest

Treating critically ill COVID-19 patients with corticosteroid drugs reduces the risk of death by 20 per cent, an analysis of seven international trials found on Wednesday, prompting the World Health Organization to update its advice on treatment.

The analysis — which pooled data from separate trials of low dose hydrocortisone, dexamethasone and methylprednisolone — found that steroids improve survival rates of COVID-19 patients sick enough to be in intensive care in hospital.

"This is equivalent to around 68 per cent of [the sickest COVID-19] patients surviving after treatment with corticosteroids, compared to around 60 per cent surviving in the absence of corticosteroids," the researchers said in a statement.

That suggests that if the drugs had been used from the beginning of the pandemic, more than 170,000 people may have been saved out of the 860,000 who have died around the world of COVID-19 so far.

The trials — conducted by researchers in Britain, Brazil, Canada, China, France, Spain, and the United States — gave a consistent message throughout, showing the drugs were beneficial in the sickest patients regardless of age or sex or how long patients had been ill, said Jonathan Sterne, a professor of medical statistics and epidemiology at Britain's Bristol University who worked on the analysis.

Dr. John Marshall is a Toronto doctor who co-chaired a special World Health Organization clinical research team behind the analysis.

"It's a robust kind of effect," he told CBC News. "It's a drug that we know very well and its safety profile is well established. And it's inexpensive and quite broadly available."

The findings, published in the Journal of the American Medical Association, reinforce results that were hailed as a major breakthrough and announced in June, when dexamethasone became the first drug shown to be able to reduce death rates among severely sick COVID-19 patients.

Dexamethasone has been in widespread use in intensive care wards treating COVID-19 patients in some countries since then.

Martin Landray, a professor of medicine and epidemiology at the University of Oxford who worked on the dexamethasone trial that was a key part of the pooled analysis published on Wednesday, said the results mean doctors in hospitals across the world can safely switch to using the drugs to save lives.

Results are 'clear,' but treatment not a cure

"These results are clear, and instantly usable in clinical practice," he told reporters. "Among critically ill patients with COVID-19, low-dose corticosteroids ... significantly reduce the risk of death."

Researchers said the benefit was shown regardless of whether patients were on ventilation at the time they started treatment. They said the WHO would update its guidelines immediately to reflect the fresh results.

The WHO initially warned against using steroids for COVID-19 because they were ineffective for the coronavirus disease SARS and potentially harmful.

Until the June findings on dexamethasone, no effective treatment had been shown to reduce death rates in patients with COVID-19, the respiratory disease caused by the novel coronavirus.

It's still not clear why corticosteroids help patients with COVID-19, but researchers like Dr. Todd Rice at Tennessee's Vanderbilt University have a theory.

"It's becoming more and more clear that a later phase of this disease is dominated by an inflammatory component and hyper inflammation," he told CBC News. "And I think steroids are very good at decreasing that inflammatory component." 

More than 25 million people worldwide have been infected with COVID-19 and 856,876 have died, according to a Reuters tally.

Gilead Sciences Inc.'s remdesivir was authorized by United States regulators in May and Canadian regulators in July for use in patients with severe COVID-19 after trial data showed the antiviral drug helped shorten hospital recovery time.

Anthony Gordon, an Imperial College London professor who also worked on the analysis, said its results were good news for patients who become critically ill with COVID-19, but would not be enough to end outbreaks or ease infection control measures.

"Impressive as these results are, this is not a cure. We now have something that will help, but it is not a cure, so it's vital that we keep up all the prevention strategies."