Dexamethasone for COVID-19 patients

Dexamethasone: evidence-based treatment for hospitalised COVID-19 patients

Colin Garner Coronavirus COVID-19, Learn more

Often, new diseases are treated using existing medicines for other conditions. This allows us to move more quickly than if we were to develop and test a new treatment, but with so many possible candidates the process must be based in science. Dexamethasone use for COVID-19 patients shows this process at its best.

In a previous article we explored the series of events that led to hydroxychloroquine, an entirely unsuitable treatment, being given to patients suffering from COVID-19. The anti-malaria medicine was approved for emergency use, despite the fact that the studies exploring its efficacy had not published detailed data. Eventually, it was realised that the drug did more harm than good to people who were already very sick.

Now, a new possible treatment has been identified for COVID-19: dexamethasone. This a steroid which is both an anti inflammatory and immunosuppressive drug. It’s currently widely used for a range of conditions. Dexamethasone also has a relatively low risk of serious side effects.

How is dexamethasone different?

Dexamethasone was a chosen candidate for the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial. The trial was run by the University of Oxford and operates through a network of hospitals across the country. This steroid treatment was trialled at a low dose in more than 2,000 patients with COVID-19.

According to an article preprint, published 22 June 2020:

“Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14).

Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone.”

The RECOVERY trial uses a best-practice approach to evidence-based science and medicine. It allows clinicians to be sure that the treatment is a) beneficial and b) does not pose an unreasonably high risk of serious side effects, before they have to administer it. Interestingly, hydroxychloroquine was also tested in a different arm of this trial. It was found to have no benefit at all in patients with COVID-19, so it’s not surprising that its early use ended in near-disaster.

The methods used in RECOVERY are the gold standard in clinical pharmacology that we should be striving to achieve. If the research for a potential treatment is carried out elsewhere in the world, we must demand that the same quality of methods is used and that the detailed data is published.

More on dexamethasone

Dexamethasone is a corticosteroid that relieves inflammation. It prevents white blood cells from travelling to the site of the swelling. It is widely used for reducing swelling associated with tumours, as well as to treat eye inflammation. Dexamethasone can help treat allergic reactions and be used in cancer treatments too. Often, it is also used to replace endogenous steroids in patients with adrenal insufficiency. It can be administered as a pill, eye drops, intravenously or a topical lotion, depending on the condition it is used to treat.

Other steroids

Steroids are often thought of as treatments that bodybuilders take to rapidly build muscles. These are not the same type of steroid discussed in this article. Muscle-building effects come from anabolic steroids.

Corticosteroids, such as dexamethasone, are widely used in medicine to reduce inflammation. As white blood cells are part of the body’s immune response, it is important that drugs that restrict their movement, such as dexamethasone, are tested properly. This is to ensure their benefit before they are given to patients who are already very unwell.

Many corticosteroids are used in the treatment of sepsis, an often-fatal condition caused by the immune system over-responding to an infection. However, this practice is controversial (in terms of whether or not it is of any real benefit). Its use has been the topic of various reviews and editorials. The key difference between dexamethasone and steroid treatments to COVID-19 and sepsis patients, and the decision to give hydroxychloroquine to COVID-19 patients, is that these steroids are widely used. They have well-understood and relatively harmless side effects. Hydroxychloroquine, on the other hand, is known to cause heart complications.

Other steroids, such as prednisolone – which is used to treat arthritis – are not considered as part of this trial. If you are taking steroids, the current advice is to continue to do so. Contact your GP to discuss it if you develop the symptoms of COVID-19, when they may alter your dose. You can find out more HERE.

Antibiotic Research UK

The treatments in this article are not new medicines. They are existing medicines for other illnesses that have been repurposed to use in people with COVID-19. This way of discovering possible treatments is faster, easier, cheaper and safer than developing new drugs. Our charity’s work focuses on antibiotic-resistant infections, includes research into the repurposing of drugs in order to save lives. We also aim to help reduce the overuse and misuse of our existing antibiotics, which are vital for so many medical procedures. For example, we are investigating antibiotic resistance breakers, which are existing drugs – or combinations of existing drugs – that can render bacteria susceptible to treatments that they had developed resistance to. Although complicated, this is infinitely less expensive and time consuming than developing a new antibiotic therapy.

We are the only charity in the world who focus on research into antibiotic-resistant bacterial infections, while also providing support to those affected by such infections and educating the public about related issues. COVID-19, while not caused by bacteria or susceptible to treatment with antibiotics, is of global relevance. Many of the issues highlighted by this global pandemic are issues that we may face again in the future. We need to act now against antibiotic resistance to prevent future global health crises.

If you want to help, you can protect yourself and others against all types of infection by following our simple guide and sharing it with your loved ones. You can also find out more about how to support our work to protect antibiotics for future generations.