This month JAMA published several studies looking at the efficacy of steroids in severe COVID-19. The REAMP-CAP paper suggested some benefit for hydrocortisone in patients, data analysis used complex Bayesian statistics, which are beyond the capability of this author to explain. The trial was stopped early and no treatment strategy met pre-specified criteria for statistical superiority, precluding definitive conclusions. However, the meta-analysis from the WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group showed benefits for corticosteroids more generally. This meta-analysis was of 7 randomised trials, across 12 different countries including 1,703 patients with severe SARS-CoV-2 infection in an intensive care setting, of whom 647 died. Patients received intravenous dexamethasone, hydrocortisone or (in a small number of cases) methylprednisolone. There were 222 deaths among the 678 patients randomised to corticosteroids and 425 deaths among the 1,025 patients randomised to usual care or placebo (summary odds ratio, 0.66 [95% CI, 0.53-0.82]; P<0.001 based on a fixed-effect meta- analysis). This is exciting news in the management of severe COVID-19. From an endocrine perspective, it does not affect the usual management of patients with adrenal insufficiency (AI) and the NHS England central pharmacy team are aware that hydrocortisone is a critical drug for AI patients, so are monitoring stocks on a weekly basis, which should provide reassurance for our patients.

Read the full articles in JAMA doi:10.1001/jama.2020.17022 and doi:10.1001/jama.2020.17023