"We are at war", warned Emmanuel Macron in mid-March.
It took a long time, but our first weapons to lead it are coming.
"We have a treatment which acts like a missile, crushing the entire inflammatory reaction", summarizes Jean-Michel Constantin.
This "Fat Bertha", as the head of intensive care at Pitié-Salpêtrière (Paris, 13th century) calls it, it is corticosteroids.
Known for a long time, these drugs seem to be a real brake against the worsening of the disease.
The professor is not based only on his own experience with the most severe coronavirus patients.
These are the conclusions of a study conducted by French researchers, published this Wednesday in the prestigious scientific journal Jama.
A parallel publication to a meta-analysis coordinated by the World Health Organization (WHO) of seven international trials (and 1703 patients).
According to all of this work, "corticosteroid therapy" would reduce the risk of mortality from severe forms of Covid-19 by 21%.
Unexpected potential
"It's simple: corticosteroids save lives and, in addition, they do it at low doses", enthuses Djillali Annane, head of intensive care in Garches (Hauts-de-Seine), co-pilot of the '' one of the trials, Cape-Covid (149 patients were included from March 7 to June 1 and received, blindly, either a corticosteroid or a placebo).
However, initially, the specialist in these treatments for three decades did not suspect their potential on the front of the epidemic.
“In March, we thought the Covid looked like the flu.
However, we know that to treat the latter, corticosteroids are deleterious.
It was when we understood that the two diseases had nothing to do with it, that they appeared as a working hypothesis, says the doctor.
Faced with the virus, the body sometimes starts to react too strongly, an internal storm sets in, creating collateral damage which leads to death.
Corticosteroids, these so-called steroidal anti-inflammatory drugs, then intervene.
Especially no self-medication
In its service, it is hydrocortisone that is privileged, the natural hormone discovered in the 1950s. But the demonstration has also been made with Dexamethasone or Methylprednisolone.
"Ultimately, the drug does not matter as long as it belongs to the class of corticosteroids," resumes Djillali Annane.
There are about ten synthetic molecules, some of which are well known to asthmatics or people with chronic rheumatism.
"
But beware of the temptation to self-medicate.
“That would be bullshit!
sums up Jean-Michel Constantin.
For the minor forms, not only has no benefit been demonstrated but they can lead to secondary infections.
They are effective for patients with moderate form who are hospitalized and who require oxygen.
Or for patients in intensive care, on mechanical ventilation.
"
New data expected in the coming months
"Today, it is clear that it is necessary to give it, before resuscitation, to patients who need oxygen", abounds Professor Annane, who sees there a "turning point in the fight against the epidemic".
New data are expected in the coming months, particularly on longer-term patient follow-up, specify the study investigators such as the Assistance publique-Hôpitaux de Paris (AP-HP), the CHU de Tours or even Inserm.
Hope in corticosteroids, better ventilation of patients, less invasive procedures… “We have made a lot of progress in the care of patients,” notes Jean-Michel Constantin with optimism.
The next step, according to him: to move from heavy artillery to treatment in lace.
“Today, with corticosteroids, we have the missile.
Now we need the sniper.
"
