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Originator: CMO Messaging

From: CMO Messaging

Issue date: 03-Sep-2020 09:01:32

This alert has been issued to:
  • NHS Foundation Trusts (England) - Medical Director
  • NHS Foundation Trusts (England) - Chief Executive
  • NHS Trusts (England) - Medical Director
  • NHS Trusts (England) - Chief Executive

  • MHRA (Medicines) Drug Alerts (Various Recipients)
  • Other contacts
  • Independent Healthcare Providers (registered with CAS)
  • Clinical Commissioning Groups
  • NHS Regional Offices
  • Special Health Authorities
  • CMO Urgent Messages - Non-NHS Recipients on Public Health Link
  • MHRA (Medicines) Drug Alerts - Non-NHS Recipients
  • Territorial CMOs in Northern Ireland, Scotland & Wales
  • Regional Directors of Public Health
  • Consultants in Communicable Diseases
  • CMO Urgent Messages - Recipients on Public Health Link
  • Director of Public Health
  • DHSC Supply Disruption - Medicines

Action category: Important information for immediate action

Title: Corticosteroids in the treatment of suspected or confirmed COVID-19

Broadcast content:
Corticosteroids, and in particular dexamethasone and hydrocortisone, have been demonstrated to have a place in the management of patients with COVID-19. Following recent publication of the REMAP-CAP trial for hydrocortisone and a meta-analysis of corticosteroids, the World Health Organization (WHO) has recently issued new interim guidance recommending the use of systemic corticosteroids in severe and critical COVID-19 disease.

The revised WHO recommendations for the use of dexamethasone or hydrocortisone in the management of patients with severe or critical COVID-19 makes two recommendations:
  1. a strong recommendation for systemic (intravenous or oral) corticosteroid therapy in patients with severe and critical COVID-19, and 
  2. a conditional recommendation not to use corticosteroid therapy in patients with non-severe3 COVID-19. 
It should be noted that the WHO guidance is intended to apply globally, and that healthcare conditions can vary significantly from country to country. In the UK setting, the WHO guidance is likely to apply primarily to patients with COVID-19 who are hospitalised and receiving supplemental oxygen. However, there may be occasions when UK patients with COVID-19 meet the WHO criteria of severe or critical but are not hospitalised, in which case the WHO guidance for treatment would apply.

Further information can be found in the attached alert. 

Please note that this alert replaces the previously issued alerts regarding Dexamethasone in the use of COVID-19. The most recent of which, CEM/CMO/2020/026 was published on 16 June.

Additional information: This alert does not need to be cascaded to Primary Care.

Alert reference: CEM/CMO/2020/033


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