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Explained: How corticosteroids help in fighting the novel coronavirus pandemic


New Delhi, Sep 09: Recently, the World Health Organization (WHO) issued new guidelines on the use of corticosteroids for the treatment of novel coronavirus. The results of meta-analysis that pooled data from eight randomised clinical trials, the WHO has made two recommendations that corticosteroid therapy be used for 7 to 10 days in patients with severe and critical COVID-19 and that it not be used in patients with non-severe COVID-19.


What are corticosteroids?

Corticosteroids are low-cost anti-inflammatory drugs that mimics cortisol, the hormone naturally produced by the adrenal glands in humans. It can be seen that they are commonly used in treatment for rheumatological inflammatory conditions: inflammations of muscles, inflammation of blood vessels, chronic arthritis, and lupus.

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

Earlier, the researchers from Oxford, leading the RECOVERY clinical trials in the UK had announced that dexamethasone reduced death by up to one-third in hospitalised COVID-19 patients who develop acute respiratory complications. The dexamethasone has been part of standard clinical management protocol adopted by many countries.

What are the findings of the newly published meta-analysis?

According to reports, the study reported 222 deaths among the 678 patients randomised to corticosteroids, and 425 deaths among the 1,025 randomised to usual care or placebo.

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"This corresponds to an absolute mortality risk of 32 per cent with corticosteroids compared with an assumed mortality risk of 40 per cent with usual care," it said.

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

"In this prospective meta-analysis of clinical trials of critically ill patients with coronavirus, administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality," it said.

What are the new WHO guidelines?

In a report, the WHO has said, "We recommend systemic corticosteroids rather than no systemic corticosteroids for the treatment of patients with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence)."

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The WHO also pointed out that in contrast to other experimental treatment that is expensive and 'difficult' to obtain and require 'advanced medical infrastructure', corticosteroids are 'low cost, easy to administer, and readily available globally'.

"Accordingly, systemic corticosteroids are among a relatively small number of interventions for Covid-19 that have the potential to reduce inequities and improve equity in health. Those considerations influenced the strength of this recommendation," it said.

What are the limitations of the new study?

The findings is significant because it is on a relatively large number of critically ill patients with COVID-19 from geographically diverse sites. However, the study reported that optimal dose and duration of treatment could not be assessed in the analysis.

What is India's clinical management protocol on corticosteroids?

However, the Indian government, in June issued revised guidelines on clinical management of COVID-19 patients, where it recommended dexamethasone as an alternative to another steroid, methylprednisolone, for moderate to severe cases.

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