NHS to start using the steroid hydrocortisone on Covid-19 patients as it boost ...

The NHS has promised to start using the steroid hydrocortisone on Covid-19 patients with 'immediate action' after a study found it can improve outcomes by up to 93 per cent.

Critically ill patients who received the drug intravenously for seven days had a 93 per cent better recovery odds - measured by either a greater chance or survival or less need for organ support. 

The findings come from the REMAP-CAP trial, involving more than 50 research teams around the world in around 13 countries, including 88 patients treated at Imperial College Healthcare NHS Trust Hospitals.

It's one of three studies, published today in The Journal of the American Medical Association (JAMA), that suggests steroids improve survival of the sickest COVID-19 patients. 

Another was an analysis of seven different studies which found three steroids - hydrocortisone, methylprednisolone and dexamethasone - reduce the risk of death in critically ill coronavirus patients by 20 per cent.

Dexamethasone has already been approved by NHS officials for use on critically ill patients after results of the world's biggest Covid-19 drug trial found it could cut their risk of death.

Oxford University scientists claimed it may save up to 35 per cent of patients relying on ventilators — the most dangerously ill — and reduce the odds of death by a fifth for all patients needing oxygen at any point. 

NHS chief executive Sir Simon Stevens said today: 'Just as we did with dexamethasone, the NHS will now take immediate action to ensure that patients who could benefit from treatment with hydrocortisone do so, adding a further weapon in the armoury in the worldwide fight against Covid-19.'

The World Health Organisation will be issuing new guidelines to include the use of steroids to treat critically ill Covid-19 patients today.   

Critically ill patients who received hydrocortisone (pictured) intravenously for seven days had a 93 per cent better recovery odds - measured by either a greater chance or survival or less need for organ support

Critically ill patients who received hydrocortisone (pictured) intravenously for seven days had a 93 per cent better recovery odds - measured by either a greater chance or survival or less need for organ support

NHS chief executive Sir Simon Stevens said today: 'Just as we did with dexamethasone, the NHS will now take immediate action to ensure that patients who could benefit from treatment with hydrocortisone do so, adding a further weapon in the armoury in the worldwide fight against Covid-19'

NHS chief executive Sir Simon Stevens said today: 'Just as we did with dexamethasone, the NHS will now take immediate action to ensure that patients who could benefit from treatment with hydrocortisone do so, adding a further weapon in the armoury in the worldwide fight against Covid-19'

WHAT IS DEXAMETHASONE?

Dexamethasone is a type of corticosteroid medication which is used as an anti-inflammatory to treat a wide-rang of conditions.  

It was first made in 1957 by US physician Philip Showalter Hench and was approved for medical use in 1961. 

The drug, which is sold under the brand names Ozurdez and Baycadron, is on the World Health Organization's List of Essential Medicines. 

It is given via an injection or a once-a-day tablet and is used to treat a variety of afflictions. 

It is even used to help reduce the side effects of chemotherapy in cancer patients.  

The steroid is also used to treat  conditions that cause inflammation, conditions related to immune system activity, and hormone deficiency.

These include:

allergic reactions rheumatoid arthritis  psoriasis  lupus eczema   flare-ups of intestinal disease, such as ulcerative colitis  multiple sclerosis pre-treatment for chemotherapy to reduce inflammation and side effects from cancer medications adrenal insufficiency (a condition where the adrenal glands don't produce enough hormones)

Dexamethasone is known to cause a number of mild to moderate side effects, including vomiting, heartburn, anxiety, high blood pressure, muscle weakness and insomnia. 

 What did the RECOVERY trial show?

On June 16, 2020, a trial to test possible treatments for coronavirus patients was started by the Nuffield Departments of Public Health and of Medicine at the University of Oxford.

While the trial is expected to continue until June 2021, a preliminary report on its findings was published on July 18. 

Some 11,800 Covid-19 patients had enrolled in the trial as of June. 

The trial, Randomised Evaluation of COVID-19 therapy (RECOVERY) trial, found dexamethasone improves survival rates of hospitalised patients with Covid-19 receiving oxygen or on a ventilator. 

However, this was only the case in patients who were struggling to breathe and needed respiratory support.  

People who didn't require breathing support saw a worse survival rate if they were treated with the drug, although this may have been coincidence.  

The World Health Organisation (WHO) states that dexamethasone should be reserved for seriously ill and critical patients receiving COVID-19 treatment in a hospital setting.

The WHO Director-General said: 'WHO emphasizes that dexamethasone should only be used for patients with severe or critical disease, under close clinical supervision. There is no evidence this drug works for patients with mild disease or as a preventative measure, and it could cause harm.' 

Based on those preliminary results, dexamethasone treatment has been recommended by the National Institutes of Health in the US, and by the NHS in the UK.

It's only for patients with Covid-19 who are mechanically ventilated or who require supplemental oxygen but are not mechanically ventilated.

Dexamethasone has not been recommended in patients with COVID-19 who do not require supplemental oxygen or hospitalisation. 

How does it help Covid-19 patients?    

In coronavirus patients, the steroid reduces inflammation in the lungs triggered by an overreaction by the immune system.

One in 10 symptomatic Covid-19 patients are thought to suffer from the nasty symptom, known as acute respiratory distress syndrome (ARDS). 

ARDS causes the immune system to become overactive and attack healthy cells in the lungs.

This makes breathing difficult and the body eventually struggles to get enough oxygen to vital organs.  

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The REMAP-CAP trial is led in the UK by Professor Anthony Gordon from Imperial College London with collaborators from the Intensive Care National Audit & Research Centre. 

Professor Gordon, Chair in Anaesthesia and Critical Care at Imperial and a Consultant in Intensive Care Medicine at Imperial College Healthcare NHS Trust, said: 'At the beginning of the year at times it felt almost hopeless, knowing that we had no specific treatments. It was a very worrying time. 

'Yet less than six months later, we've found clear, reliable evidence in high quality clinical trials of how we can tackle this devastating disease.'

The work was funded by the National Institute for Health Research and supported by the NIHR Imperial Biomedical Research Centre.

Professor Gordon added: 'The studies published today show that we now have more than one choice of treatment for those who need it most. 

'Steroids are not a cure, but they help improve outcomes. Having a choice of different types of steroids, all of which seem to improve patient recovery, is great as it helps ease the problem of drug supply issues.'      

Steroids are anti-inflammatory drugs, and evidence strongly suggests that they reduce the lung inflammation in patients with COVID-19 who are seriously ill and require oxygen support for their breathing difficulties.

In the latest study, 403 patients with suspected or confirmed COVID-19  were enrolled between March and June 2020.

They each required respiratory or cardiovascular organ support, such as mechanical ventilation or drugs to support their blood pressure.

The cohort included patients of mixed ethnicities in the UK, Ireland, Australia, the US, the Netherlands, New Zealand, Canada

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