Corticosteroid drugs significantly reduced deaths among critically ill patients with Covid-19, according to a new meta-analysis of more than half a dozen randomized controlled trials.
The analysis, published in the Journal of the American Medical Association, incorporated data on a total of 1,703 patients across five continents, 488 of whom were women, across seven clinical trials of the corticosteroids dexamethasone, hydrocortisone and methylprednisolone. The analysis was carried out by the World Health Organization’s Rapid Evidence Appraisal for Covid-19 Therapies Working Group.
Across all seven studies, all-cause mortality at the 28-day mark was lower among patients receiving the drugs than it was among those receiving usual care or placebo, with 222 deaths among the 678 patients randomized to corticosteroids and 425 among the 1,025 randomized to usual care or placebo. The summary odds ratio was 0.66, meaning that exposure to one of the corticosteroids was associated statistically with lower odds of death, corresponding with a 32% absolute mortality risk in those getting the drugs and a 40% assumed risk among those in the control groups.
Among individual drugs, the odds ratio was 0.64 across the three trials of dexamethasone, with a 30% absolute risk of mortality, and 0.69 across the three trials of hydrocortisone, with a 32% risk. There was only one trial of methylprednisolone, which enrolled 47 patients and had an odds ratio of 0.91. An odds ratio of 1 would indicate no effect from the drug, and an odds ratio greater than 1 would indicate a detrimental effect.
In June, results from the Phase II/III RECOVERY trial of severely ill Covid-19 patients showed that dexamethasone reduced death rates among patients with Covid-19 who required mechanical ventilation or oxygen. That report was based on a sample of 6,425 patients randomized to receive the drug or usual care and showed an absolute reduction in death by 2.8%, particularly among those who required ventilation, with 29.3% dying, compared with 41.4% of those receiving usual care. The meta-analysis authors noted that the signal seen in the trial resulted in most ongoing studies of corticosteroids suspending recruitment.
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