A team of researchers from the University of Edinburgh Centre for Inflammation Research, the Queen’s Medical Research Institute Edinburgh, and Roslin Institute at the University of Edinburgh says that, based on evidence from previous outbreaks of similar types of infection such as SARS, steroids provide little benefit to patients and could do more harm than good. The scientists say that clinicians should still administer the treatment for conditions such as asthma and other inflammatory diseases.
Transmission electron microscopic image of an isolate from the first U.S. case of 2019-nCoV. The spherical extracellular viral particles contain cross-sections through the viral genome, seen as black dots. Image credit: C.S. Goldsmith & A. Tamin / CDC.
Steroids are often used by doctors to reduce inflammation, which is present in the lungs of patients with novel coronavirus.
Lung inflammation was observed during the SARS and MERS outbreaks, which were caused by coronaviruses.
However, steroids also impair the immune system’s ability to fight viruses and other infections that often develop in patients with life-threatening illness.
“On balance, using the drugs could cause significant harm,” said Roslin Institute’s Dr. J. Kenneth Baillie and colleagues.
One retrospective study of critically-ill patients with MERS found that almost half of the people that received steroids needed additional treatments such as assistance in breathing, drugs to increase blood pressure, and a form of dialysis.
Those given steroids were found to take longer to clear the virus from their bodies.
Other studies found that steroids caused harm in the SARS outbreak, with the virus still present in those who took the drugs up to three weeks after infection.
“During this current coronavirus outbreak clinicians are faced with some tough decisions on how to treat people who have been infected,” Dr. Baillie said.
“After looking carefully at what evidence is available, we would advise that steroids should not be used for treatment of lung injury caused by this new virus.”
“If steroids are used, it should be as part of a clinical trial so that we can find out if they are helping or harming patients.”
The team’s paper was published in The Lancet.
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Clark D. Russell et al. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. The Lancet, published online February 7, 2020; doi: 10.1016/S0140-6736(20)30317-2
