It’s not just dexamethasone: Other steroids may be used to treat critically ill COVID-19 patients, study says
Dexamethasone isn’t the only steroid that has shown promise in the battle against COVID-19.
Researchers at the Albert Einstein College of Medicine and Montefiore Health System led a study in which most of their patients took prednisone, another steroid in the same family as dexamethasone, and found patients with high inflammation levels were associated with a 75% reduction in risk of going on mechanical ventilation or dying.
The study, published in the peer-reviewed Journal of Hospital Medicine, also sought to pinpoint a window in which these steroids would be the most beneficial to patients with COVID-19, the illness caused by SARS-CoV-2 virus.
Authors of the Einstein-Montefiore study found a simple blood test could dictate when a doctor should treat their patient with steroids. The blood test measures levels of C-reactive protein, which the liver produces in response to inflammation.
Steroid use in patients with a CRP level greater than 20 was associated with a reduced risk of mechanical ventilation or death. However, if CRP levels were less than 10, steroid use was associated with a 200% increased risk.
“Our findings suggest that steroid therapy should be reserved for people with high inflammation,” said senior author Dr. William Southern, professor of medicine and chief of the division of hospital medicine at Einstein and Montefiore. “It’s a different story for people who do not have significant inflammation: For them, any benefit is outweighed by the risks from using steroids.”
Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City, said that using steroids too early in the infection process could inhibit the body’s immune system from doing its job of clearing the virus.
Remdesivir and COVID-19: New data suggests the experimental drug can shorten how long people are sick
Dexamethasone: Demand for drug rises after study finds COVID-19 benefits, FDA data shows
“You don’t want to give the steroid too early on,” he said. “We need to be really clear in defined windows when these drugs have their most beneficial effect.”
But the choice between using dexamethasone or prednisone is less consequential.
According to Glatter, dexamethasone is stronger and longer lasting. While some clinicians may prefer to give dexamethasone, other doctors may prefer to prescribe prednisone because a shorter window of activity gives them more opportunity to scale the drug back if needed.
Although these steroids have “small differences,” Glatter says they “all act similarly.”
Southern said the observational study didn’t compare the two drugs, but researchers didn’t see a difference between prednisone and dexamethasone. However, some doctors may prefer dexamethasone because it induces the body to hold onto salt and water the least.
“In general, when people have difficulty breathing and require ventilation, one of the things you don’t want them to have is excess salt and water in their body,” he said.
Vitamin C has had a surge in popularity amid the coronavirus pandemic, even though the effectiveness of the antioxidant is unknown.
Both Glatter and Southern say these drugs could become a game-changer for treating critically ill COVID-19 patients because steroids are cheap and widely available worldwide.
But Southern stresses steroids are not for everyone and it may be too soon to begin prescribing steroids in an outpatient setting. While some people may have taken steroids in the past and have leftover amounts in their medicine cabinet, he urges people not to take them if they’ve tested positive for COVID-19 unless directed by their doctor.
People should never self-medicate with steroids, as the risks for harm are real, he said.
“One of the key things we’ve learned is that the answer of the question ‘are steroids helpful?’ is not straightforward,” he said. “There’s a considerable amount of work to do yet to better define who those patients are.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.