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Clinical trial shows common steroid improves recovery and survival for Covid-19 ICU patients

By Irish Pharmacist - 29th Sep 2020

Serious dark skinned young woman being on self isolation at home, wears protective medical mask, being on quarantine at home, dressed casually, poses against pink background. Coronavirus disease

A global study involving more than 200 intensive care units around the world has found that delivering intravenous hydrocortisone, a corticosteroid, improves recovery and survival for critically ill Covid-19 patients.
The findings were reported in the Journal of the American Medical Association (JAMA) as part of a four-article package. The World Health Organisation is updating its Covid-19 treatment guidance as a result.

The Health Research Board (HRB) helped fund the Irish arm of this trial, which was set up by a group of intensive care specialists from around the world. It is led in Ireland by Prof Alistair Nichol, St Vincent’s University Hospital and University College Dublin. Irish hospitals and patients participated in the trial.

According to Prof Nichol: “The REMAP-CAP Trial was designed to be able to quickly recruit patients in response to emerging pandemics such as Covid-19. So, in March 2020, our team of investigators began randomising patients with Covid-19 to alternative hydrocortisone dosing strategies and compared their outcomes with patients who received no corticosteroid.”

The study involved 384 adult participants globally, and the research found a 93 per cent probability that giving this common steroid to patients improved their recovery and survival. The results were consistent across age, race and sex.

“These results build on the success of existing evidence that dexamethasone, another corticosteroid, also improves outcomes for Covid-19 patients, confirming that this class of anti-inflammatory drugs can make a real difference in the fight against Covid-19,” said Prof Nichol.

“Data from REMAP-CAP also contributed by combining data with other corticosteroid trials to confirm these results. Overall, this is an important extension of current knowledge that gives clinicians an alternative corticosteroid to use in case of shortages in availability of dexamethasone.”

Dr Mairead O’Driscoll, Chief Executive at the HRB, added: “This rapid response to address critical cases of Covid-19 is possible as a result of long-term investment by the Health Research Board in both the Irish Critical Care Clinical Trials Network at the UCD Clinical Research Centre, and in clinic research infrastructures across Ireland. It is good to see that by having this infrastructure in place, we can help deliver such timely and relevant outcomes for patients with Covid-19.”

Since 2007, the HRB has invested more than €160 million in Ireland’s clinical research ecosystem. The paper, ‘Effect of Hydrocortisone on Mortality and Organ Support in Patients with Severe Covid-19’, was published in JAMA as part of a four-article package.

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