A study from early in the global coronavirus pandemic that evidenced the benefits of using steroids to combat COVID-19 in severely ill patients could have saved lives, according to the University of Huddersfield researchers involved.
Dr Hamid Merchant and Dr Syed Shahzad Hasan assessed the results of using corticosteroid such as dexamethasone on hospitalized COVID-19 patients with acute respiratory distress syndrome (ARDS) on respiratory support.
By mid-April they had found that the proportion of COVID-19 patients who died in the steroid group was significantly lower compared to those who did not receive corticosteroids, at 28 per cent compared to 69 per cent. Their research has now been published in the Expert Review of Respiratory Medicine following a lengthy period of scrutiny and peer review.
The Huddersfield academics’ work highlights the issues involved in scrutinizing scientific evidence, as well as costs involved in research and the UK’s preference for evidence-based practice. Oxford University’s RECOVERY trial came to similar conclusions as the Huddersfield researchers in mid-June, leading to the UK government’s decision that dexamethasone could be made available to patients, a move subsequently taken around the world.
The World Health Organisation (WHO) had, early in the pandemic, recommended that steroids should not be used to combat COVID-19 due to perceived risk of delayed coronavirus clearance. Despite warnings from WHO, various global bodies acknowledged the mortality benefits of using steroids on COVID-19 patients with ARDS, such as the National Health Commission & State Administration of Traditional Chinese Medicine (NHC), Surviving Sepsis Campaign (SSC), and the National Institute of Health (NIH).
“What this shows is that providing evidence is not cheap,” says Dr Merchant. “It comes at a very high cost; it not only costs time and money but may even cost precious lives. The background of the pandemic highlights this, it’s something that we have known for years but unfortunately has been thrown into sharp relief by coronavirus,” he adds.
“There is always a dilemma of the risks versus the benefits of evidence-based practice in a medical emergency,” says Dr Hasan. “The WHO advice confused a lot of people and many countries stayed away from using steroids due to risks of diminishing immune response.”
Dr Merchant adds that, “The benefits of using steroids outweighs the risks. There is a risk that the immune system may go down and there is a possibility of delayed viral clearance from the body, but this is a risk worth taking if it saves lives.”
Reference: Hasan et al. (2020). Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis. Expert Review of Respiratory Medicine. DOI: https://doi.org/10.1080/17476348.2020.1804365
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