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Steroid Story in COVID-19
Dr Swapnil Pawar
The role of corticosteroids in treating severe infections has been debatable for some time. During the coronavirus disease 2019 (COVID-19) pandemic, rigorous data on the efficacy of corticosteroids have been limited. As of July 24, 2020, 55 studies of corticosteroids for the treatment of COVID-19 have been registered on ClinicalTrials.gov. In early July, The Randomized Evaluation ofCOVID-19 Therapy (RECOVERY) trial reported its findings from 6425 patients randomized to 6mg/d of dexamethasone or usual care. Overall, dexamethasone resulted in an absolute reduction in mortality of 2.8 %( 22.9%vs 25.7%for usual care; age-adjusted rate ratio, 0.83 [95%CI, 0.75- 0.93]). The benefit was greatest for patients who were receiving invasive mechanical ventilation at the time of randomization with mortality of 29.3%for dexamethasone vs 41.4%for usual care (rate ratio, 0.64 [95%CI,0.51-0.81]). The signal seen in this trial led most ongoing trials of corticosteroids to suspend recruitment.
Subsequently, The Clinical Characterisation and Management Working Group of the World Health Organization (WHO) conducted a prospective meta-analysis of ongoing randomised clinical trials.
In this prospective meta-analysis of 7 randomized clinical trials that included 1703 critically ill patients with COVID-19 recruited from countries on 5 continents, administration of corticosteroids was associated with –
Limitations of Meta-analysis –
Our Conclusion –
Based on the results of the RECOVERY trial and the meta-analysis performed by REACT group of WHO, we strongly recommend the use of corticosteroids in all severely ill patients with COVID-19.