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Most adults with moderate to severe Covid-19 have a suppressed immune response against the novel coronavirus rather than life-threatening hyperinflammation, according to a study suggesting steroids like dexamethasone should be reserved for sicker patients. .
Scientists, including those from St. Jude Children’s Research Hospital in the United States, assessed levels of immune system protein cytokines and other health markers in 168 adults with Covid-19, 26 adults with influenza, and 16 healthy volunteers.
They said more than 90 percent of Covid-19 patients were hospitalized and about half in the intensive care unit (ICU), while more than half of the flu patients were hospitalized for treatment and 35 percent was in intensive care.
According to the research, published in the journal Scientific advances, less than 5% of patients with Covid-19, including some of the sickest individuals, have had the life-threatening hyperinflammatory immune response known as cytokine storm syndrome.
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The researchers explained that cytokine storms develop when excessive or abnormally regulated levels of cytokine proteins in the body lead to hyper-inflammation and tissue damage.
While dexamethasone and other steroids are prescribed to treat cytokine storms, they said these drugs can backfire on patients whose immune response is already suppressed.
“We identified a subset of Covid-19 patients with the largely upregulated range 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. of St Jude Children’s Research Hospital.
Based on the findings, the scientists said the treatment that suppresses inflammation could only be effective in a minority of patients with a hyperinflammatory profile.
They believe the need for the hour is a fast, reliable, and inexpensive test for measuring cytokines and identifying 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 useful,” said Philip Mudd, another co-author of the study from the Washington University School of Medicine in the United States.
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