A research group known as the WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) initiative completed a meta-analysis of seven multinational clinical trials supported by the World Health Organization (WHO) and led by a team of investigators from St. Michael’s Hospital of Unity Health Toronto and the National Institute for Health Research (NIHR) at the University of Bristol in the United Kingdom. This group’s findings build on those from the RECOVERY Trial in the UK: corticosteroids can in fact reduce the probability of death among those critically infected with SARS-COV-2, the virus behind COVID-19, by 20%. With results published in the Journal of the American Medical Association (JAMA), the WHO now updates its treatment guidelines incorporating this class of medication as a weapon against COVID-19. An important reinforcement of a critical clinical trial led by University of Oxford.
TrialSite News breaks down this update for clarity.
What are Corticosteroids?
They are a class of steroid hormones produced by the adrenal cortex of vertebrates as well as the synthetic analogues of these hormones. Two main classes of corticosteroids include glucocorticoids and mineralocorticoids, and they are both involved in a range of physiological processes such as stress response, immune response, and regulation of inflammation and more.
Synthetic pharmaceutical drugs with corticosteroids-like effects are used to treat a variety of conditions ranging from brain tumors to skin diseases. The UK Recovery Trial used Dexamethasone, which along with its derivatives are nearly pure glucocorticoids, while prednisone and its derivatives involve some mineralocorticoid action in addition to glucocorticoid effect.
What was the RECOVERY Trial and Why is it Important?
As TrialSite reported back in June, the RECOVERY Trial in the UK represented a real breakthrough in addressing select COVID-19 patient scenarios. Specifically, Peter Horby of University of Oxford led this study demonstrating that dexamethasone, a corticosteroid, could reduce deaths by up to one third in severely ill hospitalized patients.
A quoted by Professor Horby, a Professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford and lead investigator, “Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result. The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become the standard of care in these patients. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”
The study reveals that Dexamethasone can save lives for those patients who are critically ill and mechanically ventilated or require supplemental oxygen but are not mechanically ventilated. The drug is not recommended for those COVID-19 patients who don’t require supplemental oxygen or hospitalization.
The RECOVERY trial’s results influenced the United States as the NIH moved to include the corticosteroid on a national treatment guideline for COVID-19.
Who is behind the WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) initiative Study?
Actually, a large multinational group of investigators from the United Kingdom, United States, Canada, France, China, Brazil and Spain is behind this study. The team was led by St. Michael’s Hospital of Unity Health Toronto and the National Institute for Health Research (NIHR) at the University of Bristol. The corresponding author is Jonathan A.C. Sterne, MA, MSc, PhD, Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK.
What does this new study reveal?
This latest meta-analysis covering seven clinical trials involving critically ill patients in ICU due to critical COVID-19 reveals that the use of dexamethasone or hydrocortisone actually reduced mortality from 40% down to 32% for a overall reduction of 20%.
Key Investigator Point of View
Dr. John Marshall, senior scientist at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital of Unity Health Toronto, and co-chair of the WHO Working Group on Clinical Characterization and Management, quoted, “Even beyond the clear evidence of benefit for an inexpensive and widely available medication, the process of this work—pooling data across seven clincial trials conducted over a period of only three months—highlights the willingness of researchers around the world to share data in a new research model that can bring reliable evidence rapidly to improve the care of patients with COVID-19.”
Dr. John Marshall, senior scientist at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital of Unity Health Toronto, and co-chair of the WHO Working Group on Clinical Characterization and Management.
Note, there are many authors—for more information, go to the source below.
Call to Action: Follow the link to see the published results.