“If you use them,” Cron said, “you want to do it in patients who are having an overly exuberant immune response.”
The U.K. trial that tested dexamethasone found that only certain hospitalized patients benefited. In this case, it was those who were sick enough to need oxygen or a mechanical ventilator. The drug cut their risk of dying by one-fifth to one-third.
But when hospital patients were not on respiratory support, the drug was no help.
The current study turned up a different line of demarkation: Blood levels of a substance called C-reactive protein (CRP), a marker of inflammation.
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, the study authors reported.
That finding may be the more important one, according to study co-author Dr. Shitij Arora, a hospitalist at Montefiore and associate professor at Albert Einstein College of Medicine in New York City.
It highlights a group of patients, Arora said, that could actually be harmed by steroid treatment.
CRP tests are standard and cheap, according to Arora. But it’s not clear that CRP alone is the best way to identify patients who should receive steroids, he said. Other lab tests, in combination with CRP, might be even better, both Arora and Cron said.
And is prednisone as good as dexamethasone?
Arora said he suspects the benefits of dexamethasone reflect a “class effect,” and are not limited to that one drug. But, he stressed, that’s an “opinion.” Clinical trials are needed to prove a treatment works.
Ongoing studies are testing other steroids. For his part, Cron said he’d be “very surprised” if dexamethasone was the only effective one. Having additional options would be a good thing, he noted, so the world is not reliant on one drug.
The findings were published online July 22 in the Journal of Hospital Medicine.
WebMD News from HealthDay
SOURCES: Shitij Arora, MD, associate professor, medicine, Albert Einstein College of Medicine and hospitalist, Montefiore Medical Center, Bronx, N.Y.; Randy Cron, MD, PhD, professor, pediatrics and medicine, director, pediatric rheumatology, University of Alabama at Birmingham;Journal of Hospital Medicine, July 22, 2020, online
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