The COVID-19 pandemic has put the world on edge and has led to a scramble by doctors and researchers to find an effective treatment for the virus. In the search for possible treatments, corticosteroids have emerged as a common option for reducing inflammation in patients with severe COVID-19 symptoms. However, new research highlights the risks associated with overusing corticosteroids, particularly for those being treated with non-invasive oxygen therapy. A recent study shows that more corticosteroids can increase the risk of death by 60% in COVID-19 patients with low oxygen levels. This article delves into the study’s findings, highlighting the implications of overusing corticosteroids and how to manage the use of the drug in treating COVID-19 patients.
The RECOVERY Collaborative Group, led by Prof Sir Peter Horby and Prof Sir Martin Landray at the University of Oxford, has conducted a study on the effects of high-dose corticosteroids on COVID-19 patients needing oxygen therapy or no breathing support. The results show that, compared with standard care that included low-dose corticosteroid use, treating hypoxic COVID-19 patients with higher dose corticosteroids is associated with a 60% increased risk of death. The study, to be presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2023) and published in The Lancet, had previously identified that low-dose corticosteroids reduce mortality for patients with COVID-19 requiring oxygen or ventilatory support. From May 2021 to May 2022, the RECOVERY trial evaluated the use of a higher dose of corticosteroids in this patient group. However, in May 2022, the independent Data Monitoring Committee advised that this treatment assessment be stopped for those patients receiving oxygen alone or no breathing support.
Eligible adult patients with COVID-19 and clinical evidence of hypoxia were randomly allocated to either usual care with higher dose corticosteroids or usual standard of care alone. Of 1272 patients with COVID-19 and hypoxia receiving no oxygen or simple oxygen only, 659 patients were allocated to receive usual care plus higher dose corticosteroids while 613 patients were allocated to usual care alone. Of those randomly assigned, 745 were in Asia, 512 in the UK, and 15 in Africa. Overall, 123 of 659 patients allocated to higher dose corticosteroids versus 75 of 613 patients allocated to usual care died within 28 days. There was also an excess of pneumonia reported to be due to non-COVID infection in the higher-dose corticosteroid group and an increase in hyperglycaemia requiring an increased insulin dose.
The authors of the study conclude that among hospitalised patients with COVID-19 who require oxygen or ventilatory support, low-dose corticosteroids reduce the risk of death. However, among patients requiring simple oxygen only, higher doses of corticosteroids increase the risk of death compared with low-dose corticosteroids. It remains unclear whether using a higher dose of corticosteroids is beneficial among patients requiring non-invasive or invasive ventilation—the RECOVERY trial continues to study this.
The RECOVERY trial is supported by a grant to the University of Oxford from UK Research and Innovation/ the National Institute for Health Research (NIHR), and by core funding provided by the Bill and Melinda Gates Foundation, the Foreign, Commonwealth & Development Office, Health Data Research UK, the Medical Research Council Population Health Research Unit, the NIHR Oxford Biomedical Research Centre, NIHR Clinical Trials Unit Support Funding, and Wellcome. Funding for RECOVERY outside the UK is provided by Wellcome through the COVID-19 Therapeutics Accelerator. The trial is conducted by Oxford Population Health’s registered clinical trials units in partnership with the Nuffield Department of Medicine and currently involves many thousands of doctors, nurses, pharmacists, and research administrators at 178 hospitals across the whole of the UK.
The findings of this study provide valuable information about the use of corticosteroids in treating COVID-19 patients with low oxygen levels. It is important for healthcare professionals to carefully weigh the risks and benefits of using these drugs in these specific cases, and to monitor patients closely for any adverse effects. While corticosteroids have been shown to be effective in treating severe COVID-19 cases, it is crucial to ensure that the treatment plan is tailored to the individual needs of each patient. By staying vigilant and informed, we can continue to provide the best possible outcomes for COVID-19 patients.
