The Infectious Diseases Society of America (IDSA) has updated its treatment guidelines to include generic steroid pills for patients hospitalized with severe COVID-19, the disease caused by the new coronavirus.
The only other drug the medical group recommends for COVID-19 patients outside of a clinical trial is remdesivir, the intravenous antiviral medication made by Gilead Sciences Inc.
The IDSA late on Thursday said its change was based on recent data from a United Kingdom study showing that a low-cost and widely used steroid called dexamethasone reduced death rates by around a third among the most severely ill hospitalized COVID-19 patients.
The group now suggests dexamethasone, or an equivalent steroid such as methylprednisolone or prednisone, for hospitalized COVID-19 patients who require supplemental oxygen, mechanical ventilation or extracorporeal mechanical oxygenation (ECMO). The IDSA does not recommend steroids for COVID-19 patients who do not require supplemental oxygen.
In patients with severe COVID-19, the immune system can overreact, triggering a potentially harmful cascade. Steroids are an older class of drugs used to suppress that inflammatory response, but they can also make it easier for other infections to take hold - and doctors are leery of their use in a hospital setting, or in patients in earlier stages of the illness when they body's immune response needs to be on high alert.
The IDSA recommends remdesivir for hospitalized patients with severe COVID-19, but supplies of the antiviral drug are tight. The guidelines note that remdesivir appears to offer the most benefit for patients who need oxygen, but are not on a ventilator or ECMO.
Gilead has not yet set a price for remdesivir, which has been available on a limited basis through company donations, compassionate use requests and clinical trials.
The Institute for Clinical and Economic Review this week suggested a price range for remdesivir of $2,520 to $2,800 per treatment course if dexamethasone becomes a standard treatment for COVID-19. The U.S. price for dexamethasone is around $15 for a 10-day course of treatment.