Widely available drug may boost survival rates
A team of researchers in England has discovered that an affordable, widely available steroid has shown promise in improving survival outcomes in COVID-19 patients.
Dexamethasone, a common steroid used to treat inflammation, was found to cut deaths by up to one-third in a study of more than 6,000 severely ill patients. More than 2,100 received the drug.
Although the British government has authorized its use among some patients, it remains unclear how beneficial the treatment may be for less severe COVID-19 cases. Further, it has not been peer-reviewed or replicated in other studies.
“This is a significant improvement in the available therapeutic options that we have,” said Dr. Anthony Fauci, the United States’ top infectious disease expert.
What we know about the potentially lifesaving treatment:
What is dexamethasone?
Usually prescribed as an oral or intravenous steroid, dexamethasone is a general purpose anti-inflammatory and anti-swelling drug used for a variety of conditions, said Dr. Onyema Ogbuago, an infectious disease doctor and associate professor of medicine at Yale.
Dexamethasone is unique, he says, in that it is a glucoocorticoid – meaning it helps maintain blood pressure.
Dr. Robert Glatter, an emergency physician at New York City’s Lenox Hill Hospital, said dexamethasone also has a half-life of up to 54 hours. That helps “to assure a therapeutic level of medication to treat ongoing inflammation.”
Like other steroids, however, “it is a non-specific treatment not necessarily targeting a single, specific pathway of inflammation or swelling,” Ogbuago says. That has its drawbacks.
How is it used to treat COVID-19 patients?
Generally, COVID-19 comes in two phases, explains Ogbuago.
“People get the virus, it replicates, and that’s the first phase of the illness,” he said. “Afterward, around 10 days into
the infection, people start to produce antibodies and inflammatory reactions to the virus.”
These inflammatory chemicals can sometimes create severe COVID-19 complications, such as acute respiratory distress syndrome, which makes it difficult for oxygen to enter the bloodstream and reach organs.
Patients with severe COVID-19 complications saw significant benefits with dexamethasone in the United Kingdom study. These patients took it for 10 days, either orally or via IV.
After a month, it had reduced deaths by 35% in patients who needed treatment with breathing machines and by 20% in those needing supplemental oxygen. It did not appear to help less ill patients.
Some studies, Ogbuago says, also have suggested that steroids such as dexamethasone are helpful in improving mortality rates among people with ARDS.
Are there complications?
Ogbuago notes that timing and selectiveness among patients is critical to ensuredexamethasone is properly used as a treatment for COVID-19.
Early findings suggest COVID-19 patients who do not have severe symptoms, such as requiring a respirator, should not take dexamethazone.
“The downside of steroids is that it’s not selective,” Ogbuago said. “It’s a double-edged sword that may hinder your body’s ability to fight the virus.”
He noted that some studies have found higher mortality rates in people who used steroids, since they inhibit the body’s immune response to the virus.
The World Health Organization and other organizations advise against using steroids earlier in the course of illness because they can impede clearing the virus.
Ogbuago also says that steroids, in general, may cause some severe side effects, such as new or worsening diabetes, as well as psychosis or emotional disturbance.
What about hydroxychloroquine?
The U.S. Food and Drug Administration revoked its emergency authorization for hydroxychloroquine, the controversial anti-malarial drug promoted by President Donald Trump for treating the coronavirus.
The agency said in a letter the decision is based on new evidence that made it unreasonable to believe hydroxychloroquine and chloroquine “may be effective in diagnosing, treating or preventing” COVID-19, the illness caused by the virus.
Citing reports of heart complications, the FDA said the drugs pose a greater risk to patients than any potential benefits.