COVID-19 has been ravaging the world for more than nine months, and in that time multiple medications—namely hydroxychloroquine (which had its emergency use authorization revoked by the FDA) and remdesivir (currently in the lead for proven, albeit modest benefits in treatment)—have been touted as "game-changers" in the fight against the virus.
Now, researchers believe another drug may be a beneficial treatment for the sickest coronavirus patients: dexamethasone. The new information comes from a statement released from chief investigators on a large clinical trial in the UK, regarding a study on dexamethasone's effectiveness in reducing COVID-19-related deaths in hospitalized patients. The study's results were so promising that researchers are suggesting the drug "should now become a standard of care" in COVID-19 patients who are sick enough to require oxygen treatment.
President Trump, who revealed that he had tested positive for the coronavirus late last week, has also been given dexamethasone as a treatment, according to CNN. This announcement left many wondering just how serious the president's condition is, since dexamethasone is associated with severe illness caused by COVID-19. In fact, the National Institutes of Health (NIH) has recommended against administering dexamethasone to patients who don't also require the use of supplemental oxygen.
Of course, any leads for a possible COVID-19 treatment for the severely ill is good news, but some doctors are hesitant to jump on the dexamethasone bandwagon just yet. Here's what we know so far about the study in question, what doctors say we need to be cautious about, and what dexamethasone is typically used for.
What is dexamethasone, and what is it used for?
Dexamethasone is a generic, low-cost corticosteroid that’s used to relieve inflammation. It’s similar to steroids like prednisone and cortisone, Robert Weber, PharmD, pharmacy administrator at The Ohio State University Wexner Medical Center, tells Health. “It works by blocking the inflammation response in the body,” he says. “Steroids [in general] suppress the immune system to counteract the body’s response to inflammation.”
Dexamethasone in particular has "potent anti-inflammatory properties," according to the National Center for Biotechnology Information, which means it's often called in to treat conditions in which someone has a lot of inflammation. Those conditions include: arthritis, colitis, and lupus, as well as a bad muscle strain, or a virus that causes a bad inflammatory reaction, Kathryn Boling, MD, a primary care physician at Baltimore's Mercy Medical Center, tells Health. The drug may also be used to treat certain types of cancer, and to potentially reduce brain inflammation after a head injury, adds Jamie K. Alan, PharmD, PhD, an assistant professor in the Department of Pharmacology and Toxicology at Michigan State University, tells Health.
What do we know about dexamethasone as a COVID-19 treatment?
The aforementioned study, which was conducted by researchers at the University of Oxford, is part of a randomized clinical trial called the Randomised Evaluation of COVid-19 thERapY (RECOVERY) trial. It was created in March to test a range of potential treatments for COVID-19 on more than 11,500 patients from 174 hospitals in the UK. The study, of course, included low-doses of dexamethasone, but it also included other treatment possibilities for COVID-19, including:
- Lopinavir-Ritonavir, a drug commonly used to treat HIV.
- Hydroxychloroquine, the trial for which has now been stopped due to lack of efficacy.
- Azithromycin, a commonly used antibiotic.
- Tocilizumab, an anti-inflammatory treatment given by injection.
- Convalescent plasma, from people who have previously recovered from COVID-19.
Overall, the dexamethasone study included 2,104 patients who were randomly assigned to receive 6 milligrams of dexamethasone once a day, either by mouth or IV injection, for 10 days. Their results were compared with 4,321 patients who were given standard care.
In the patients who just received standard care, 41% died on a ventilator within 28 days, 25% of those who received supplemental oxygen died, and 13% of those who didn’t receive any respiratory help died. But, in patients who were given dexamethasone, deaths were reduced by 1/3 in patients on a ventilator, and by 1/5 in those who were given supplemental oxygen. “Based on these results, one death would be prevented by treatment of around eight ventilated patients or around 25 patients requiring oxygen alone,” the study’s authors wrote in a press release.
Overall, per the press release, dexamethasone reduced the 28-day mortality rate by 17%, showing the greatest benefits for patients who required ventilation. However, the study authors also point out that dexamethasone was found to have no evidence of benefits for patients who didn't require oxygen, and that researchers did not study patients outside of a hospital setting.
Still, "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,” wrote study co-author Peter Horby, MD, a professor of emerging infectious diseases at the University of Oxford, in the released statement. “Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”
Why might dexamethasone work on COVID-19?
The study’s authors didn’t cover that, but there are some theories from other doctors. “The straight-forward hypothesis is to reduce the inflammation caused by the virus,” Alan says. “The virus is known for inducing a cytokine storm, which causes massive inflammation.” Dexamethasone may help reduce that inflammatory response, she says.
The drug may also help prevent lung damage. “The lung damage from SARS-CoV-2 resulting in COVID-19 disease is an exaggerated inflammatory response that destroys the lungs,” Weber says. “The theory is that using steroids such as dexamethasone may curb inflammation and reduce lung damage from COVID-19.” But again, until more research is done (and until the actual study is made available) those are simply theories.
What do other doctors think about dexamethasone as a potential COVID-19 treatment?
The doctors we spoke to who were not involved in the RECOVERY study are hopeful, but taking the news with a grain of salt. “There are many randomized clinical trials going on of different drugs to use against the novel coronavirus,” Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, tells Health. He points out that interest in steroids to treat COVID-19 patients has “waxed and waned,” adding that “past studies have not shown a benefit.”
Boling also points out that, when patients are sick enough to be put on a ventilator, doctors will often try anything to help them get better. “If things are getting worse and worse, the patient may die,” she says. “At that point, the potential benefit of using something unproven outweighs the risks. You want to throw everything you have at them.” For that reason, Alan says it can’t hurt to use the drug. “Unless there are specific contraindications, it's probably a good drug to try, especially if the patient is experiencing a cytokine storm,” she says. “I am hopeful, and it makes sense to use this medication, but time will tell.” So right now, it's fine to believe the news about dexamethasone is a step in the right direction, but remember that more research and reviews are needed before it's touted as a definite treatment for serious illness from COVID-19.
The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.
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