Why are steroids helpful?

Dr Elena Schneider-Futschik features in ABC news story on latest corticosteroid treatment data and reducing death rates of COVID-19 patients.

Corticosteroids are synthetic drugs that suppress the immune system and decrease inflammation, pain and swelling.

Early on in the coronavirus pandemic, these steroids were used to treat critically-ill coronavirus patients but at the time didn’t have evidence from clinical trials to show overall impacts on the virus and mortality rates. Since then, research into corticosteroid treatments on patients has advanced and recent publications have pointed to their effectiveness.

Dr Elena Schneider-Futschik from the Department of Pharmacology, spoke to the ABC on the recent findings.  One study involving the meta-analysis of preliminary results of seven randomised clinical trials, covering three types of corticosteroids: dexamethasone, hydrocortisone, and methylprednisolone was published in the Journal of the American Medical Association (JAMA).

The meta-analysis has found that treating critically ill patients with corticosteroids improved survival rates by up to a third.

“COVID-19 could cause an immune system 'hyper-response' in some patients. When you have a severe reaction, your own body attacks itself, and that's what causes symptoms and death. Corticosteroids dampen immune response which helps when critically ill COVID-19 patients' immune systems overreact to the virus," Dr Schneider-Futschik explains.

“On one hand pooling the results from the seven different studies from twelve different countries paints a bigger picture than looking at one study. But the different studies are fundamentally quite different, and the analysis of the pooled study is not as straightforward,” says Elena.

“Based on the results of the UK-based Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial the Task Force for the Australian guideline for the clinical care of people with COVID-19 recommend the use low dose dexamethasone - 6 mg daily intravenously or orally - for up to ten days in adults who are receiving oxygen (including mechanically ventilated patients). But currently have an conditional recommendation against using dexamethasone in adults with COVID-19 who do not require oxygen therapy.”

In this study, Elena points out, a major question is left unanswered: What is the optimal dose?

While low-dose corticosteroids have been shown to be beneficial, using high-dose corticosteroids for COVID-19 has been associated with the risk of secondary infections, long-term complications and prolonged virus shedding.

The meta-analysis indicates that these steroids may increase the risk of death in patients with non-severe COVID-19. Not everyone who has COVID-19 should be treated with corticosteroids.

"Corticosteroids suppress the immune system and this is actually a negative impact in the case of a mild infection," Dr Schneider-Futschik says.

Dr Schneider-Futschik says more evidence is needed about which corticosteroids were best for treating severe COVID-19, and at what dose levels.

Original article published 6 Sept 2020, ABC News

Read article