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Some people who get COVID-19 are asymptomatic and don’t even know they have it. Others experience symptoms such as fever, cough, and shortness of breath for weeks. And the most severe cases wind up in the hospital intensive care unit, fighting for their lives.
While there are different reasons why COVID-19 can turn fatal, a substantial subset of critically ill patients struggle to survive thanks to a cytokine storm, an inappropriately strong immune response to the virus that ends up damaging healthy cells.
The good news is that doctors have been making major strides in figuring out how to best treat the out-of-control inflammation and, in turn, save lives of people with serious cases of COVID-19.
The key, it seems, may be a well-timed dose of steroids, in some cases coupled with a medication called an interleukin inhibitor, which is also used to treat certain rheumatic diseases.
Last month, researchers at the University of Oxford released preliminary results from the RECOVERY trial, which found that giving severely ill COVID-19 patients the steroid dexamethasone substantially cut their chances of dying from virus-related complications. The results were later published in the New England Journal of Medicine.
Now a new study, this one published in the journal Annals of the Rheumatic Diseases, has determined that high doses of a different steroid, methylprednisolone — sometimes combined with the IL-6 inhibitor tocilizumab — may be lifesaving for COVID-19 patients battling cytokine storms.
The new study, which was conducted in the Netherlands, focused on 86 hospitalized patients who developed cytokine storms and were treated with high doses of IV methylprednisolone for five days.
Those who did not improve sufficiently within a few days were also given tocilizumab (Actemra), a drug that targets the inflammatory cytokine IL-6 and is often used by people with rheumatoid arthritis.
The researchers then compared how these patients fared compared to another group of 86 patients who had previously been treated at the same hospital but was only given supportive therapies, such as supplemental oxygen and IV fluids.
According to their findings, the methylprednisolone treatment (which sometimes included tocilizumab) reduced the chances that a patient would die in the hospital by 65 percent.
“A strategy involving a course of high-dose methylprednisolone, followed by tocilizumab if needed, may accelerate respiratory recovery, lower hospital mortality and reduce the likelihood of invasive mechanical ventilation in COVID-19-associated [cytokine storm syndrome],” the authors concluded.
The authors noted that this was not a randomized controlled trial, and that other inflammation-fighting medications, such as TNF inhibitors or IL-1 antagonists might work as well but require further study.
What People with Rheumatic Conditions Need to Know About This Treatment
Just because these drugs appear to be useful in treating patients who are experiencing severe COVID-19 complications does not mean that people who take them regularly for a chronic health condition, such as rheumatoid arthritis, are protected from COVID-19. In fact, people who use oral steroids such as prednisone have a higher than average risk of contracting COVID-19 because these drugs suppress the immune system.
The research suggesting that steroids may be beneficial for COVID-19 only applies to severe cases in which patients have developed an out-of-control immune response that needs to be reined in to avoid damaging healthy tissue.
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Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report.” The New England Journal of Medicine. July 17, 2020. doi: https://doi.org/10.1056/NEJMoa2021436.
Mayor S. Intensive immunosuppression reduces deaths in covid-19-associated cytokine storm syndrome, study finds. BMJ. July 22, 2020. https://doi.org/10.1136/bmj.m2935.
Ramiro S, et al. Historically Controlled Comparison of Glucocorticoids With or Without Tocilizumab Versus Supportive Care Only in Patients With COVID-19-Associated Cytokine Storm Syndrome: Results of the CHIC Study. Annals of the Rheumatic Diseases. July 2020. doi: https://doi.org/10.1136/annrheumdis-2020-218479.