What is Dexamethasone?

As the world struggles to flatten the curve of the novel coronavirus, a low-cost drug is appearing to offer some medical respite from the Covid-19 pandemic. Researchers in England say they have the first evidence that the widely available steroid called dexamethasone reduced deaths by up to one third in severely ill ventilated patients, reports The Indian Express. 

The observation was based on a clinical trial called RECOVERY (Randomised Evaluation of COVid-19 therapy) to test potential treatments for Covid 19, including a steroid treatment with low-dose dexamethasone.

The drug was given either orally or through an IV. After 28 days, it had reduced deaths by 35 per cent in patients who needed treatment with breathing machines and by 20 per cent in those only needing supplemental oxygen. It, however, did not appear to help less ill patients.

So, what is dexamethasone?

“Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide,” said Peter Horby, a study leader of the University of Oxford, and one of the Chief Investigators for the clinical trial.

Dexamethasone is a steroid drug typically used to reduce inflammation. According to the NHS, “steroid tablets, also called corticosteroid tablets, are a type of anti-inflammatory medicine used to treat a range of conditions. They can be used to treat problems such as allergies, asthma, eczema, inflammatory bowel disease and arthritis.”

Significantly, Dexamethasone is also “the first drug to be shown to improve survival in COVID-19”. “This is an extremely welcome result. The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients,” Horby said.

Steroid drugs reduce inflammation, which sometimes develops in COVID-19 patients as the immune system overreacts to fight the infection. This overreaction can prove fatal, so doctors have been testing steroids and other anti-inflammatory drugs in such patients. The World Health Organization advises against using steroids earlier in the course of illness because they can slow the time until patients clear the virus.

The clinical trial that proved Dexamethasone to be effective

As part of the RECOVERY trial, Dexamethasone was tested on 2104 patients who received 6 mg of the drug once per day for ten days and were compared with 4321 patients randomised to usual care alone.

Based on these results, “one death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone.”

Overall dexamethasone reduced the 28-day mortality rate by 17% with a highly significant trend showing greatest benefit among those patients requiring ventilation, researches estimated.

Other methods of treatment in the ongoing trial includes the HIV drug Lopinavir-Ritonavir, antibiotic Azithromycin, anti-inflammatory treatment Tocilizumab, and Convalescent plasma. Hydroxychloroquine, the malaria drug promoted by US President Donald Trump, has been stopped due to lack of efficacy.

Source: The Indian Express