Author: Ronald L. Conte Jr.
A group of 8 researchers from a hospital in Singapore undertook a clinical study to “evaluate the efficacy of adjunctive corticosteroids in 5 the management of COVID-19” . This is “a retrospective cohort study of hospitalized adults”, all of whom had Covid-19 . The two groups, were compared to attempt to discern the possible benefits or detriments of corticosteroids as an adjunctive therapy.
Method and Results
Group A: 57 patients. No steroids; treatment with hydroxychloroquine, lopinavir and ritonavir.
Group B: 35 patients. Corticosteroids in addition to the above Group A treatment.
And while 47.8% of the patients had pneumonia, only 31.1% required supplemental oxygen at the beginning of treatment. In a comparison of the two groups, there was no statistically significant difference between them regarding the end points of need for mechanical ventilation (MV), and death.
“In weighted and adjusted cox regression analysis, patients in Group B were less likely to have clinical progression, (adjusted HR [aHR] 0.08, 95% CI 0.01-0.99, p=0.049) but there was no statistical significant difference in risk of requiring invasive MV or death (aHR 0.22, 95%CI 0.02 – 2.54, p=0.22).”
When the data was analyzed statistically, the whole of Group B was less likely to progress to a worse state (“clinical progression”), 92% less likely. But the p value was just barely statistically significant at 0.049 — anything under 0.05 is considered statistically significant.
However, in the subgroup of those patients, nearly half, who had pneumonia, use of corticosteroids showed statistically significant benefits on the end points of MV and death:
“However in those with pneumonia, there were lower proportions of patients in Group B with clinical progression (11.1% , 95% CI 0.0 – 22.2 versus 58.8%, 95% CI 27.3 – 76.7, log rank p<0.001 ); and invasive MV or death (11.3%, 95% CI 0.0 – 22.5 versus 41.2%, 95% CI 12.4. – 60.5, log rank p=0.016)."
The subgroups of A and B who had pneumonia did much better with corticosteroids than without. Clinical progression to worse state was only 11.1% in Group B compared to 58.8% in Group A. And the combined end point of MV or death was only 11.3% in B compared to 41.2% in A. The p values showed high statistical significance.
What this means is that patients with pneumonia benefit greatly from corticosteroids, in addition to the standard treatment of antivirals. Covid-19 is a steroid-responsive disease.
"In subgroup with pneumonia, patients in Group B were significantly at lower risk of clinical progression (aHR 0.15, 95% CI 0.06 – 0.39, p<0.001) and requiring invasive MV compared to Group A (aHR 0.30, 0.10-0.87, p=0.029)."
The steroid treated patients with pneumonia were 85% less likely to become worse, and they were 70% less likely to need mechanical ventilation. If you are a Covid-19 patient with pneumonia, steroids is very helpful. These numbers relate to survival. Covid-19 patients die when their case worsens ("clinical progression"), and needing mechanical ventilation is a particularly bad sign. A high percentage of MV patients (absent steroids) die. MV also is injurious to the lungs, and the survivors can have fibrosis of the lungs and a decreased quality of life. Avoiding MV is very important not only to survival but to complete recovery.
Steroids are available in every hospital. They are inexpensive and physicians often use them for a wide range of ailments, so their safety profile is well-known. The conclusion of this study, that steroids work well for Covid-19 patients who have pneumonia, means that we should be able to reduce the death rate and reduce the need for ventilators very substantially.
Ronald L. Conte Jr.
Note: the author of this article is not a doctor, nurse, or healthcare provider.
1. Tat, Ooi Say, et al. “Adjunctive Corticosteroids for COVID-19: A Retrospective Cohort Study.” medRxiv, July 21, 2020; https://doi.org/10.1101/2020.07.18.20157008