While dexamethasone and other steroids are prescribed to treat cytokine
storms, scientists say these drugs can backfire in patients whose immune
response is already suppressed.
Most adults with moderate-to-severe COVID-19 have a suppressed immune response against
the novel coronavirus rather than life-threatening hyper-inflammation, according to a study
which suggests steroids such as dexamethasone should be reserved for the sickest patients.
Scientists, including those from St Jude Children’s Research Hospital in the US, assessed the
levels of the immune system protein cytokines and other health markers in 168 adults with
COVID-19, 26 adults with flu and 16 healthy volunteers.
They said more than 90 per cent of the COVID-19 patients were hospitalised and about half in
the intensive care unit (ICU) while more than half of flu patients were admitted for treatment
and 35 per cent were in the ICU.
According to the research, published in the journal Science Advances, fewer than 5 per cent of
the COVID-19 patients, including some of the sickest individuals, had the life-threatening,
hyperinflammatory immune response known as the cytokine storm syndrome.
The researchers explained that cytokine storms develop when excess or abnormally regulated
levels of cytokine proteins in the body lead to hyperinflammation and tissue damage.
While dexamethasone and other steroids are prescribed to treat cytokine storms, they said these
drugs could backfire in patients whose immune response was already suppressed.
“We did identify a subset of COVID-19 patients with the broadly upregulated array of
cytokines. But, overall, the average person with COVID-19 had less inflammation than the
average person with flu,” said study co-author Paul Thomas from St. Jude Children’s Research
Hospital.
Based on the findings, the scientists said treatment suppressing inflammation might only be
effective in a minority of patients with the hyperinflammatory profile.
They believe the need of the hour is a fast, reliable, and inexpensive test to measure cytokines
and identify patients who are most likely to benefit from dexamethasone treatment.
“Directing immunosuppressive therapies to the small subset of COVID-19 patients who have
an overactive immune response is the only way to know if these approaches are ultimately
helpful,” said Philip Mudd, another co-author of the study from the Washington University
School of Medicine in the US.
https://www.tribuneindia.com/news/health/steroid-treatment-should-be-reserved-for-sickestcovid-
19-patients-say-scientists-170671
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