WHO has updated the guidelines on the use of steroids in COVID-19 patients as an expert panel strongly recommended using systemic glucocorticosteroids for severely and critically ill patients.
The recommendation is based on two meta-analyses which pooled data from eight randomised trials involving 7184 participants.
The evidence from the data suggested that systemic corticosteroids probably reduce 28-day mortality in patients with critical COVID-19
The panel recommends systemic corticosteroid therapy, e.g. 6 mg of dexamethasone orally or intravenously daily or 50 mg of hydrocortisone intravenously every 8 hours for 7 to 10 days in patients with severe and critical COVID-19.
All or almost all fully informed patients with severe or critical COVID-19 would choose treatment with systemic corticosteroids, according to the agency.
At the same time, the panel warned that systemic corticosteroids may increase the risk of death when administered to patients with mild or non-severe COVID-19.
“We recommend systemic corticosteroids for the treatment of patients with severe and critical COVID-19. We suggest not to use corticosteroids in the treatment of patients with non-severe COVID-19 as the treatment brought no benefits, and could even prove harmful,” WHO said in a statement.
WHO defines critical COVID-19 by the criteria for acute respiratory distress syndrome (ARDS), sepsis, septic shock or other conditions that would normally require the provision of life-sustaining therapies, such as mechanical ventilation (invasive or non-invasive) or vasopressor therapy.
Whereas, severe COVID-19 is defined by any of: oxygen saturation < 90% on room air; respiratory rate > 30 breaths per minute in adults and children > 5 years old; ≥ 60 in children less than 2 months; ≥ 50 in children 2–11 months; and ≥ 40 in children 1–5 years old; signs of severe respiratory distress (i.e. accessory muscle use, inability to complete full sentences; and in children, very severe chest wall indrawing, grunting, central cyanosis, or presence of any other general danger signs).
In July 2020, published results from the RECOVERY trial found that in patients receiving hospital treatment for severe respiratory complications of COVID-19, there were fewer deaths in those treated with dexamethasone. In patients on invasive mechanical ventilation, 29% of those treated with dexamethasone died within 28 days of starting dexamethasone treatment compared with 41% of patients receiving usual care, a relative reduction of about 35%. In patients receiving oxygen without mechanical ventilation, the figures were 23% with dexamethasone and 26% with usual care. No reductions in death occurred in patients who were not receiving oxygen therapy or mechanical ventilation.