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The widely used and cheap steroid hydrocortisone can lower coronavirus deaths by a THIRD


The cheap steroid hydrocortisone can cut Covid-19 deaths in the sickest patients by almost a third, research has shown.

An analysis of seven different studies coordinated by the World Health Organization (WHO) found that three steroids – hydrocortisone, methylprednisolone and dexamethasone – reduced the risk of death in critically ill coronavirus patients by 20 percent.

Hydrocortisone, a drug used to treat allergic diseases, skin conditions, ulcerative colitis, arthritis, lupus, multiple sclerosis, or lung problems, achieved up to 31 percent.

The University of Bristol study is one of three studies published today in the Journal of the American Medical Association (JAMA) suggesting that steroids improve survival for the most seriously ill Covid-19 patients.

Another hydrocortisone found can improve outcomes in critically ill patients by up to 93 percent – measured in terms of a greater chance or greater survival or a reduced need for organ support in the intensive care unit.

The results come from the REMAP-CAP study, which involved more than 50 research teams in around 13 countries worldwide, including 88 patients treated in the NHS Trust Hospitals of Imperial College Healthcare.

Today's announcement makes hydrocortisone the second widely used steroid that is a breakthrough treatment for Covid-19.

Dexamethasone was approved for use in critically ill patients by NHS officials after results showed it reduced the risk of death.

Oxford University scientists claimed dexamethasone could save up to 35 percent of ventilator-dependent patients – the most dangerously ill – and reduce the likelihood of death by one-fifth for all patients who need oxygen at any point.

Sir Simon Stevens, CEO of the NHS, said today: “Just like we did with dexamethasone, the NHS will now take immediate action to ensure that patients who might benefit from hydrocortisone treatment do so, and globally Record fight against another weapon in armory Covid19. & # 39;

The World Health Organization issued the same guidelines recommending the use of the drug.

Critically ill patients who received intravenous hydrocortisone (picture) for seven days had a 93 percent better chance of recovery – measured either by a greater chance or a higher survival or a lower need for organ support

Sir Simon Stevens, executive director of the NHS, said today: "The NHS will take immediate action now to ensure that patients who might benefit from hydrocortisone treatment do so."

Sir Simon Stevens, executive director of the NHS, said today: "The NHS will take immediate action now to ensure that patients who might benefit from hydrocortisone treatment do so."

Today's journal issue, which published three clinical studies and a meta-analysis, concluded that a number of steroids – all safe, cheap, and readily available – can improve outcomes for patients treated in the intensive care unit.

Steroids are anti-inflammatory drugs, and there is strong evidence that they reduce pneumonia in seriously ill patients with Covid-19.

WHAT IS HYDROCORTISON AND HOW DOES IT HELP COVID-19 PATIENTS?

Hydrocortisone is a widely used steroid that is used to control the body's immune system and reduce swelling, itching, and pain.

It is used for a variety of medical conditions and can be in the form of creams, pills, or injections.

People who may have had hydrocortisone in the past include people with skin problems such as eczema or dermatitis, people with arthritis, asthmatics, or people with hemorrhoids, painful joints, persistent mouth ulcers, or colitis.

The steroid is an anti-inflammatory drug, and there is strong evidence that it may reduce pneumonia (swelling) in patients with Covid-19 who are seriously ill and need oxygen assistance because of their breathing difficulties.

Greg Kyle, Professor of Pharmacy (Head of Discipline) at Queensland University of Technology, said, "These drugs dampen the immune system's response to Covid.

& # 39; In some people with Covid-19, the immune system creates a hyperreaction for reasons that are not clearly understood.

& # 39; This severe reaction causes the body to attack itself, causing severe symptoms and death. The steroids calm this reaction – just like pruning a hedge. We don't want to kill the hedge (i.e. stop the immune system completely), we want to prune it back so that it is not rampant but controlled and still works. "

Martin Landray, professor of medicine and epidemiology at Oxford University who leads the RECOVERY study, said the data showed that hydrocortisone was not effective in patients with milder cases of the disease.

He said, 'This is not a treatment for prevention, this is not a treatment for early patients, general medicine type cases, this is a treatment for people who are sick.

"This is treatment for people in the hospital who need oxygen and who have complications from Covid."

Steroids are immunosuppressants – that is, they suppress the immune system. They are useful in conditions like lupus, which cause inflammation of the joints, skin, and other organs.

Professor Kyle said, “They are useful when the immune system is widespread, but when used on an otherwise healthy person, their immune system becomes suppressed and they may be more prone to infection – including Covid-19 or another flu pathogen. & # 39;

The review, coordinated by the World Health Organization (WHO) and analyzed by the National Institute for Health Research (NIHR) at the University of Bristol, involved an international team of researchers who analyzed seven studies in 12 countries.

There were three different types of anti-inflammatory corticosteroids.

Patient mortality was studied over a 28 day period after treatment with one of three types of corticosteroids – dexamethasone, hydrocortisone, and methylprednisolone.

The seven control studies recruited 1,703 critically ill coronavirus patients from 12 countries from February to June. The study included patients who participated in the Oxford University's RECOVERY study.

The patients were randomized to receive either one of the three drugs or a placebo.

The study found that the steroids benefited patients regardless of whether they were ventilated.

However, researchers said it appeared to have a greater effect on those who didn't need medication to support their blood pressure.

There were 222 deaths among the 678 patients randomly assigned to corticosteroids (32 percent) and 425 deaths among the 1,025 patients randomly assigned to usual treatment or placebo (41 percent).

Overall, the researchers said the steroids reduced the risk of death in critically ill coronavirus patients by 20 percent, but to varying degrees.

The researchers said the mortality outcomes were consistent across the seven studies, with dexamethasone and hydrocortisone showing "similar effects".

Dexamethasone reduced deaths by 36 percent and hydrocortisone by 31 percent.

However, too few patients were involved in methylprednisolone tests for researchers to accurately assess the effects.

Methylprednisolone was evaluated in only one study that included 47 patients, 26 of whom died. It suggested the drug reduced deaths by nine percent.

While the results are promising, it's important to note that the researchers only tracked whether the patients died 28 days later.

Stephen Evans, Professor of Pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, said, “The results are generally consistent and show that mortality has dropped significantly to around 30 to 32 percent. It is important to acknowledge that while this is a notable benefit, nearly a third of these seriously ill patients were still dying. & # 39;

He said the analysis reported in the paper was a "tour de force".

"The methods are of the highest standard for combining results from multiple studies answering the same question," he said.

Lead researcher Jonathan Sterne, Professor of Medical Statistics and Epidemiology at the University of Bristol, said, “Steroids are a cheap and readily available drug and our analysis has confirmed that they cause deaths in the people hardest hit by Covid effectively reduce. 19th

"The results were consistent and beneficial across all studies, regardless of age or gender."

He stated that the results indicated "eight fewer deaths per hundred critically ill patients using corticosteroids".

Dr. Gaetan Burgio, Department of Immunology and Infectious Diseases at the Australian National University, who was not involved in the research, said today: “I would expect WHO recommendations to fully implement the use of systemic corticosteroids in critically ill COVID patients. 19 patients who require oxygen as the standard of care. & # 39;

However, the study leaves an important question open, said Dr. Elena Schneider-Futschik, researcher in cystic fibrosis and other respiratory diseases at the Department of Pharmacology and Therapeutics at the University of Melbourne.

“What's the optimal dose?” She said, noting that all seven studies had different values.

& # 39; Low-dose corticosteroids have been shown to be beneficial. However, using high-dose corticosteroids for Covid-19 has been associated with the risk of secondary infections, long-term complications, and prolonged virus shedding.

"Treatment with corticosteroids is a double-edged sword, but the evidence shows that seriously ill patients benefit from treatment with corticosteroids."

One of the three randomized trials published today was the REMAP-CAP study conducted in the UK by Professor Anthony Gordon of Imperial College London with staff from the National Intensive Care and Research Center for Intensive Care Medicine.

Professor Gordon, Chair of Anaesthesiology and Critical Care at Imperial and Critical Care Consultant at Imperial College Healthcare NHS Trust, said, “At the beginning of the year it felt almost hopeless at times to know that we weren't having specific treatments. It was a very worrying time.

Dexamethasone was approved for use in critically ill patients by NHS officials after the results of the world's largest Covid-19 drug study showed that it could reduce the risk of death

Dexamethasone was approved for use in critically ill patients by NHS officials after the results of the world's largest Covid-19 drug study showed that it could reduce the risk of death

WHAT IS DEXAMETHASONE?

Dexamethasone is a type of corticosteroid drug that is used as an anti-inflammatory agent to treat a wide variety of conditions.

It was first made in 1957 by the US doctor Philip Showalter Hench and approved for medical use in 1961.

The drug, sold under the brand names Ozurdez and Baycadron, is on the World Health Organization's list of essential medicines.

It is given by injection or tablet once a day and is used to treat a variety of conditions.

It's even used to reduce the side effects of chemotherapy in cancer patients.

The steroid is also used to treat conditions that cause inflammation, conditions related to the activity of the immune system, and hormone deficiencies.

These include:

  • allergic reaction
  • Rheumatoid arthritis
  • psoriasis
  • Lupus
  • eczema
  • Flare-ups from bowel diseases such as ulcerative colitis
  • multiple sclerosis
  • Pre-treatment for chemotherapy to reduce inflammation and side effects of cancer drugs
  • Adrenal insufficiency (a condition where the adrenal glands don't make enough hormones)

Dexamethasone is known to cause a number of mild to moderate side effects, including vomiting, heartburn, anxiety, high blood pressure, muscle weakness, and insomnia.

What did the RECOVERY study show?

On June 16, 2020, the Nuffield Departments of Public Health and Medicine at Oxford University started a study to test possible treatments for coronavirus patients.

While the process is expected to last through June 2021, a preliminary report of its findings was released on July 18.

By June, around 11,800 Covid 19 patients had enrolled in the study.

The Randomized Evaluation of Covid-19 Therapy (RECOVERY) study found that dexamethasone improved survival rates in hospitalized patients receiving Covid-19 oxygen or using a ventilator.

However, this was only the case in patients who had difficulty breathing and needed airway support.

People who did not need breathing assistance saw poorer survival rates when treated with the drug, although it may have been a fluke.

The World Health Organization (WHO) states that dexamethasone should be reserved for seriously ill and critical patients being treated with Covid-19 in a hospital.

The WHO Director General said: “WHO stresses that dexamethasone should only be used in patients with severe or critical illness under strict clinical supervision. There is no evidence that this drug works in patients with mild medical conditions or as a preventive measure and could cause harm. & # 39;

Based on these preliminary results, treatment with dexamethasone was recommended by the National Institutes of Health in the US and the NHS in the UK.

It is only suitable for patients with Covid-19 who are mechanically ventilated or need additional oxygen but are not mechanically ventilated.

Dexamethasone was not recommended in patients with COVID-19 who do not require supplemental oxygen or hospitalization.

How does it help Covid-19 patients?

In coronavirus patients, the steroid reduces inflammation in the lungs caused by an overreaction of the immune system.

It is believed that one in 10 symptomatic Covid-19 patients will have the nasty symptom known as acute respiratory distress syndrome (ARDS).

ARDS causes the immune system to become overactive and attack healthy cells in the lungs.

This makes breathing difficult and the body eventually struggles to get enough oxygen to vital organs.

"Less than six months later, we have found clear and reliable evidence in high-quality clinical trials of how we can combat this devastating disease."

Professor Gordon added, “The studies published today show that we now have more than one treatment option for those who need it most.

“Steroids are not a cure, but they do help improve results. Choosing different types of steroids that all seem to improve patient recovery is great as it alleviates the drug supply problem. & # 39;

The REMAP-CAP study, funded by the National Institute for Health Research and supported by the NIHR Imperial Biomedical Research Center, enrolled 403 patients with suspected or confirmed Covid-19 between March and June 2020.

They each needed support for the respiratory or cardiovascular organs, such as B. mechanical ventilation or medication to support your blood pressure.

The cohort included patients of mixed races in the United Kingdom, Ireland, Australia, the United States, the Netherlands, New Zealand, Canada, and France.

The patients were randomly assigned to different treatment regimens. One group was treated with a fixed dose of 50 mg of hydrocortisone four times a day for seven days, while another group was treated with hydrocortisone only when their blood pressure dropped in what is known as the "shock dependent group".

A third group did not receive hydrocortisone, known as the "control group".

The study showed that using the fixed dose of hydrocortisone resulted in a 93 percent chance of a better outcome, as measured by a higher chance of survival and less need for organ support than not using hydrocortisone.

If the hydrocortisone was only given when the blood pressure was low, the chance of a better result was 80 percent.

Sir Stevens confirmed that the NHS would ship hydrocortisone quickly to hospitals: "One of the great things about our NHS is that we could mobilize quickly and on a large scale to help researchers test and develop proven coronavirus treatments."

Professor Jonathan Van-Tam, Deputy Head Physician, welcomed the work of British researchers and study participants.

He said: & # 39; It is impressive to see so many UK participants ready to participate in studies and able to volunteer due to the rapid recruitment response from the NIHR's Clinical Research Network.

& # 39; Research like this will make all the difference in fighting this virus.

"These results provide further evidence that corticosteroids can be an important part of COVID-19 treatment in severe patients."

The results follow the groundbreaking results of the RECOVERY study in June, which found that another steroid called dexamethasone helped improve the recovery of patients with Covid-19.

Dexamethasone reduced deaths in ventilator patients by up to a third and in oxygen patients by a fifth, which has since led to its use in the NHS.

Scientists from Brazil, Canada, China, France, Spain, Great Britain and the USA participated in the study.

Martin Landray, Professor of Medicine and Epidemiology at Oxford University who leads the RECOVERY study, said: “These drugs have been around for decades. They are the kind of drugs that every medical student learns almost immediately when they open a clinical pharmacology textbook. & # 39;

He said dexamethasone and hydrocortisone, which can be taken orally or intravenously, are "widely used, cheap and well-understood drugs".

As an example, he said that treating 12 people with dexamethasone would cost around £ 60.

He warned, however, that the “impressive” results were not enough to lead to a full resumption of life as we knew it.

He said social distancing and the wearing of face masks "remain as important as ever".

Professor Gordon, an intensive care advisor, said hydrocortisone could be used "immediately" as it was available in intensive care units in the UK.

However, Professor Landray said data showed that hydrocortisone was not effective in patients with milder cases of the disease.

He said, 'This is not a treatment for prevention, this is not a treatment for early patients, general medicine type cases, this is a treatment for people who are sick.

"This is treatment for people in the hospital who need oxygen and who have complications from Covid."

The second randomized study published today in JAMA was conducted in France under the direction of Dr. Pierre-François Dequin and Chru Hôpitaux De Tours.

However, unlike its comparative studies, hydrocortisone had no benefit in reducing death or reliance on mechanical ventilation after 21 days.

Hydrocortisone was given to 76 Covid-19 patients who were compared to 73 placebo patients. In each group, 42.1 percent and 50.7 percent of the patients died, respectively.

However, the researchers believe that not enough participants took part in the study to adequately assess whether hydrocortisone is useful for Covid-19 patients.

The study was terminated prematurely after the positive results of the dexamethasone study. The same thing happened in the REMAP-CAP study.

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