The steroid medication dexamethasone has been proven to help people severely ill with COVID-19.
In a new study, researchers found that steroids other than dexamethasone may also help battle COVID-19.
The findings are from a review of one hospital’s experience, not a clinical trial. So researchers said the results should be interpreted with some caution.
But the findings suggest that a class of cheap, long-used medications—including but not limited to dexamethasone—could aid in the COVID-19 fight.
The research was conducted by a team at Montefiore Medical Center in New York City.
The researchers looked at more than 1,800 COVID-19 patients admitted to their hospital in March and early April. Of those, 140 received a steroid within two days.
Some were treated with dexamethasone, but most received another drug called prednisone.
At first glance, steroid patients fared similarly to others: They were no less likely to die or to end up on a ventilator.
But a closer look revealed a critical difference. Among patients with signs of widespread inflammation in the body, steroid treatment cut the risk of death or ventilation by 77%.
In contrast, the medications appeared to increase those risks when patients lacked evidence of inflammation.
The team says some of the worst effects of COVID-19 are often caused not by the virus itself—but by a massive immune system response called a cytokine storm.
It floods the body with proteins (cytokines) that trigger widespread inflammation. That can cause potentially fatal organ damage.
Steroid medications like dexamethasone and prednisone—which are anti-inflammatory and suppress the immune system—make sense in that scenario.
But if a COVID-19 patient does not have serious systemic inflammation, a steroid might backfire—hampering the immune system’s ability to fight the virus.
The current study focused on blood levels of a substance called C-reactive protein (CRP), a marker of inflammation.
They found if patients’ CRP was high (20 mg/dL and up), treatment with steroids cut the risk of death or ventilation by 77%.
But if CRP was low (less than 10 mg/dL), steroid therapy more than doubled those risks.
CRP tests are standard and cheap, but it is unknown if it is the best way to identify patients who should receive steroids. Other lab tests, in combination with CRP, might be even better.
One author of the study is Dr. Shitij Arora, a hospitalist at Montefiore.
The study is published in the Journal of Hospital Medicine.
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