WHO guidance backs Use of Corticosteroids in Severe COVID-19 infection

Written By : Dr. Kamal Kant Kohli Published On 2020-09-03T10:30:32+05:30 | Updated On 3 Sept 2020 2:46 PM IST

The World Health Organization recommends systemic corticosteroids to treat patients with severe and critical COVID-19.WHO has updated its guidance for healthcare professionals and decision-makers on the use of corticosteroids in COVID-19 patients, according to a WHO press release.

Corticosteroids is a class of drug that lowers inflammation and modulates immune system activity -- for treating COVID-19 in critically ill patients.

The guidance coincides with the publication of three randomized trials and a meta-analysis on corticosteroids in JAMA.

Main recommendations-

1.The WHO recommends 6 mg of dexamethasone orally or intravenously daily or 50 mg of hydrocortisone intravenously every 8 hours for 7 to 10 days in the most seriously ill patients.

2.The organization also suggests that corticosteroids not be used to treat patients with milder COVID-19, as they may increase mortality risk in these patients.

The study, conducted by the World Health Organization (WHO) Rapid Evidence Appraisal for COVID-19 Therapies (REACT) investigators, analyzed data from 1,703 patients enrolled in the trials.

In the meta-analysis, researchers examined the results of seven trials of corticosteroids versus usual care or placebo among over 1700 critically ill COVID-19 patients. They found that 28-day mortality rate, the primary outcome, was significantly lower among corticosteroid users (32% absolute mortality for corticosteroids vs. 40% assumed mortality for controls).

The studies provide evidence and hope for an effective, inexpensive, and safe treatment for COVID 19 Infection.

In a tremendous demonstration of global collaboration, clinician-scientists have pooled data from 121 hospitals in eight countries to find that inexpensive, widely available steroids improve the odds that very sick COVID-19 patients will survive the illness.

The findings were made through the "Randomized Embedded Multifactorial Adaptive Platform-Community Acquired Pneumonia" (REMAP-CAP) trial and are reported today in JAMA as part of a four-article package.

It is relatively rare in medicine that you find drugs where the evidence of their effectiveness in saving lives is so consistent," said lead author Derek Angus, M.D., M.P.H., professor and chair of the Department of Critical Care Medicine at the University of Pittsburgh and chief health care innovation officer at UPMC. "This is, in many respects, the single clearest answer we've had so far on how to manage terribly ill COVID-19 patients. People on ventilators or oxygen and under intensive care should definitely be given corticosteroids."

Professor Gordon, from the Department of Surgery and Cancer at Imperial, added: "This been an incredible international effort. We were all aware of the other studies and were happy to share our raw data before it was published. Only by collaborating were we going to make real advances and make them fast."

At the beginning of the year, it felt almost hopeless at times, knowing that we had no specific treatments. It was a worrying time," said senior author Anthony Gordon, M.D., professor of anesthesia and critical care at Imperial College London and an NIHR research professor. "Yet less than six months later, we've found clear, reliable evidence in high-quality clinical trials of how we can tackle this devastating disease. We now have more than one choice of steroid treatment for those who need it most. Steroids are not a cure, but they help improve outcomes. Having a choice of different types of steroids, all of which seem to improve patient recovery, is great as it helps ease the problem of drug supply issues.

For further reference log on to:

WHO guidance

World Health OrganizationWHOCOVID-19steroid use in COVID-19dexamethasonehydrocortisonecorticosteroids

Source : WHO

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751