Steroids save lives. As a medication, they help against cancer, rheumatism, and Covid-19. Cortisone in particular has proven its worth. Steroids are like many substances that athletes misuse as doping agents: they originally served a good cause. In fact, without steroids, today’s medicine would be a different, less effective one.
Particularly proven steroids: glucocorticoids
The substance class of steroids is large. Anabolic steroids (anabolic steroids Canada) and the androgens that bodybuilders love to resort to are only part of it. Glucocorticoids and mineral corticoids also count among the steroids as estrogens and gestagens. The former is part of the standard therapy for many chronic diseases; the latter revolutionized contraception in the late 1960s. All birth control pills contain steroid hormones.
The discoverer of steroids, Adolf Butenandt (a chemist and biologist), specialized in researching hormones in Göttingen at the end of the 1920s. He was the first to isolate three of the five classes of steroids – estrogens, androgens, and gestagens – over the course of the following years. Butenandt’s work, for which he received the Nobel Prize in Chemistry in 1939, is considered the basis for the later artificial production of steroid hormones and their use in therapy.
Steroids alleviate Covid-19 diseases
Doctors are also fighting against Covid-19 with glucocorticoids. The European Medicines Agency (EMA) has been recommending the active ingredient dexamethasone from this steroid group since September 2020 because it reduces mortality in severe cases with mandatory ventilation, as it is called in medical jargon. The agent suppresses the immune system, so it has an anti-inflammatory effect. The World Health Organization also recommends dexamethasone in severe cases – six milligrams administered orally or intravenously for ten days. Alternatively, doctors could give 50 milligrams of hydrocortisone, also a steroid hormone, intravenously every eight hours.
The reason for the recommendations is, among other things, the “recovery study” published in July 2020 from Great Britain. According to their data, therapy with dexamethasone lowers the mortality of patients in hospitals without invasive ventilation from 25.7 to as much as 22.9 percent. In ventilated intensive care patients, the mortality rate even fell by a third under dexamethasone from 41.4 to 29.3 percent. Until then, no other drug had increased the chances of survival from a severe infection with Sars-CoV-2 to such an extent. Another study has confirmed the results; the team of authors also recommends hydrocortisone.
Frank Brunkhorst’s working group also examined this steroid and its effect on Covid-19. The intensive care doctor heads the Center for Clinical Studies at Jena University Hospital, where the researchers coordinate German participation in the “REMAP-CAP” project, an international collaboration between more than 250 intensive care units in 14 countries.
Their study results show that hydrocortisone improves the survival rate of Covid-19 intensive care patients and protects the organs with a 93 percent probability. “So hydrocortisone is a suitable therapy for the seriously ill, but not for the mildly ill who do not need to receive oxygen,” says Brunkhorst in the “Doctors Day” podcast. Dexamethasone is now scarce in some countries. “It’s good news that you can just as easily use hydrocortisone.”
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Better not to use long-term medication with steroids
Because of the promising results, steroids are now in the Covid-19 treatment guidelines. However, the funds have one disadvantage: they increase the risk of infection. This side effect is also known from other therapies, but a study from the USA appeared in December that made every cortisone advocate sit up and take notice. The authors examined around 200,000 patients with rheumatoid arthritis and found that even small doses of prednisone – the active ingredient that doctors often administer in joint disease – increase the general risk of infection.
“Because of this side effect, we always try to avoid long-term administration of cortisone and get down from high doses as quickly as possible,” explains Martin Scherer, President of the German Society for General Medicine and Family Medicine, in the “EvidenzUpdate” podcast. What is interesting: “The study raises awareness that it is worth avoiding long-term medication with steroids even at low doses.” With this knowledge, doctors would have to “weigh even more carefully,” emphasizes Scherer, “and observe very carefully how much the individual patient benefits from it.
If the benefit outweighs the risk, there is nothing wrong with using cortisone, he continues. On the contrary: Lung diseases, allergies, skin diseases – you can do magic with steroids. But certainly not to build muscle!