The World Health Organization now recommends treating severe and critical COVID-19 patients with systemic corticosteroids as standard practice, it announced Wednesday.
The guidance is based on an analysis of seven studies published in JAMA Network showing that steroids lowered mortality risk by a third in critically ill, hospitalized COVID-19 patients. After treatment with hydrocortisone, dexamethasone or methylprednisolone, participants had lower 28-day all-cause mortality when compared with usual care or placebo, a WHO working group found. Higher dosages did not make a significant difference in outcomes compared with relatively low doses.
Corticosteroid treatment was pursued by the WHO following a trial of dexamethasone in Britain that was halted when it became clear that the drug was helping patients. The U.K. government then announced that it could be used in the severely ill. The steroid was most effective in patients on ventilators or oxygen therapy without ventilators. It had no effect on people who did not receive oxygen or ventilation. The results were described as a breakthrough in the search for a treatment.
Corticosteroids are readily available and low cost. But the WHO cautioned clinicians and public health officials against giving the drugs to mild or moderately ill patients. Treatment in these cases “brought no benefits, and could even prove harmful,” the organization said in a statement. WHO likewise is recommending that countries maintain sufficient but not excessive supply of the medicines to prevent shortages.
