Widely-used and cheap steroid hydrocortisone can cut coronavirus deaths by a THIRD in sickest patients, study finds
Hydrocortisone can cut Covid-19 deaths by almost a third in the sickest patients, research has found, as the NHS has promised to start using the widely-used steroid with 'immediate action'.
An analysis co-ordinated by the World Health Organisation (WHO) of seven different studies found three steroids - hydrocortisone, methylprednisolone and dexamethasone - reduce the risk of death in critically ill coronavirus patients by 20 per cent.
It bumped up to 31 per cent for hydrocortisone, a drug widely used to treat allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, multiple sclerosis, or lung problems.
The study, from the University of Bristol, is one of three published today in The Journal of the American Medical Association (JAMA), that suggests steroids improve survival of the sickest Covid-19 patients.
Another found hydrocortisone can improve outcomes by up to 93 per cent in critically ill patients - measured by either a greater chance or survival or less need for organ support.
The results come from the REMAP-CAP trial, involving more than 50 research teams around the world in around 13 countries, including 88 patients treated at Imperial College Healthcare NHS Trust Hospitals.
Dexamethasone has already been approved by NHS officials for use on critically ill patients after results of the world's biggest Covid-19 drug trial found it could cut their risk of death.
Oxford University scientists claimed it may save up to 35 per cent of patients relying on ventilators — the most dangerously ill — and reduce the odds of death by a fifth for all patients needing oxygen at any point.
NHS chief executive Sir Simon Stevens said today: 'Just as we did with dexamethasone, the NHS will now take immediate action to ensure that patients who could benefit from treatment with hydrocortisone do so, adding a further weapon in the armoury in the worldwide fight against Covid-19.'
The World Health Organisation will be issuing new guidelines to include the use of steroids to treat critically ill Covid-19 patients today.
Critically ill patients who received hydrocortisone (pictured) intravenously for seven days had a 93 per cent better recovery odds - measured by either a greater chance or survival or less need for organ support
NHS chief executive Sir Simon Stevens said today: 'Just as we did with dexamethasone, the NHS will now take immediate action to ensure that patients who could benefit from treatment with hydrocortisone do so, adding a further weapon in the armoury in the worldwide fight against Covid-19'shares
The journal edition today, publishing three trials, concluded that a range of steroids – all safe, cheap and readily available - can improve the outcomes of patients receiving intensive care.
Steroids are anti-inflammatory drugs, and evidence strongly suggests that they reduce the lung inflammation in patients with Covid-19 who are seriously ill and require oxygen support for their breathing difficulties.
The study co-ordinated by the World Health Organisation (WHO) and analysed by the National Institute for Health Research (NIHR) at the University of Bristol, found cheap and readily available steroids reduced the risk of death in critically ill coronavirus patients by 20 per cent.
An international team of researchers analysed seven trials involving three different types of anti-inflammatory corticosteroids.
It looked at patient mortality over a 28-day period after treatment with one of three types of corticosteroids - dexamethasone, hydrocortisone and methylprednisolone.
Researchers said the estimated 20 per cent reduction in death was equivalent to about 68 per cent of critically ill patients surviving after treatment with the steroids, compared to approximately 60 per cent surviving without them.
Jonathan Sterne, professor of medical statistics and epidemiology at the University of Bristol, said: 'Steroids are a cheap and readily available medication, and our analysis has confirmed that they are effective in reducing deaths amongst the people most severely affected by Covid-19.
'The results were consistent across the trials and show benefit regardless of age or sex.'
He explained that the findings pointed to 'eight fewer deaths for every a hundred critically ill patients assigned to corticosteroids'.
The seven control trials recruited 1,703 critically ill coronavirus patients from 12 countries from February to June. The study included patients who were taking part in the Oxford University-based RECOVERY trial.
Patients were randomised to either receive one of the three drugs or a placebo.
Researchers said the mortality results were consistent across the seven trials, with dexamethasone and hydrocortisone giving 'similar effects'.
But there were too few patients involved in tests of methylprednisolone to enable researchers to estimate its impact with precision.
The study found that the steroids benefited patients regardless of whether they were on a ventilator.
But researchers said it appeared to have a greater effect on those who did not require medication to support their blood pressure.
Updated WHO guidance is due to be published on its website on Wednesday, Professor Sterne said.
Findings of the REMAP-CAP trial, led in the UK by Professor Anthony Gordon from Imperial College London with collaborators from the Intensive Care National Audit and Research Centre, were also published today.
Professor Gordon, Chair in Anaesthesia and Critical Care at Imperial and a Consultant in Intensive Care Medicine at Imperial College Healthcare NHS Trust, said: 'At the beginning of the year at times it felt almost hopeless, knowing that we had no specific treatments. It was a very worrying time.
'Yet less than six months later, we've found clear, reliable evidence in high quality clinical trials of how we can tackle this devastating disease.'
Professor Gordon added: 'The studies published today show that we now have more than one choice of treatment for those who need it most.
'Steroids are not a cure, but they help improve outcomes. Having a choice of different types of steroids, all of which seem to improve patient recovery, is great as it helps ease the problem of drug supply issues.'
In the REMAP-CAP study, funded by the National Institute for Health Research and supported by the NIHR Imperial Biomedical Research Centre, 403 patients with suspected or confirmed Covid-19 were enrolled between March and June 2020.
They each required respiratory or cardiovascular organ support, such as mechanical ventilation or drugs to support their blood pressure.
The cohort included patients of mixed ethnicities in the UK, Ireland, Australia, the US, the Netherlands, New Zealand, Canada and France.
Patients were randomly assigned to different treatment regimes. One group were treated with a fixed dose of 50mg hydrocortisone four times a day for seven days, while another group were treated with hydrocortisone only if their blood pressure dropped, known as the 'shock-dependant group'.
A third group received no hydrocortisone known as the 'control group'.
The trial showed that using the fixed dose of hydrocortisone led to a 93 per cent chance of a better outcome, measured by a greater chance of survival and less need for organ support, than not using hydrocortisone.
If the hydrocortisone was given only when the blood pressure was low, the chance of a better outcome was 80 per cent.
Confirming the NHS would fast track hydrocortisone into hospitals, Sir Stevens said: 'One of the distinctive benefits of having our NHS is that we've been able to mobilise quickly and at scale to help researchers test and develop proven coronavirus treatments.'
Professor Jonathan Van-Tam, deputy chief medical officer, hailed the work of UK researchers and trial participants.
He said: 'It is impressive to see so many UK participants willing to take part in studies, and able to volunteer due to the rapid recruitment response of the NIHR's Clinical Research Network.
'Research such as this will make the difference in controlling this virus.
'These findings offer further evidence that corticosteroids can be an important part of COVID-19 treatment for severe patients.'
The findings follow the groundbreaking results of the RECOVERY trial in June, which revealed that another steroid, called dexamethasone, helped improve recovery of patients with Covid-19.
Dexamethasone reduced deaths by up to a third among patients on ventilators, and by a fifth for those on oxygen, leading to its use in the NHS ever since.
Scientists from Brazil, Canada, China, France, Spain, the UK and the USA were involved in the study.
Martin Landray, professor of medicine and epidemiology at the University of Oxford, who leads on the Recovery trial, said: 'These drugs have been around for decades, they are the sort of drugs that every medical student learns almost as soon as they open a clinical pharmacology text book.'
He said dexamethasone and hydrocortisone, which can be taken orally or intravenously, were 'widely available, cheap, well understood drugs'.
As an example, he said treating 12 people with dexamethasone costs around £60.
But he warned that the 'impressive' results 'are not sufficient to lead to a complete resumption … of life as we knew it'.
He said that social distancing and wearing face masks 'remain as important as ever'.
Professor Gordon, an intensive care consultant, said hydrocortisone could be used 'straight away', with it being available in intensive care units in the UK.
But Professor Landray said data showed hydrocortisone was not effective in patients with milder cases of disease.
He said: 'This is not a treatment for prevention, this is not a treatment for early out patients, general practice type cases, this is a treatment for people who are sick.
'This is a treatment for people who are in hospital who need oxygen, who've got complications from Covid.'
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