Dexamethasone is a cheap and widely-used steroid in India, effective in preventing death in extremely ill COVID-19 patients on ventilators.
Dexamethasone has emerged in the news as a lifesaver for COVID-19 patients who have been hospitalised with critical symptoms. While this is true, the hype around it has doctors concerned about people misusing the steroid.
With this article, we aim to clear up possible misconceptions about Dexamethasone and provide a 360-degree view of this drug.
First, The Good News
A large UK-based clinical trial has reported that Dexamethasone helps prevent death for COVID-19 patients on ventilator support. According to a summary that was released, it improves survival rates for such critically ill patients by 35 per cent.
The drug is low-cost and easily available. In fact, it is already commonly used in intensive care in India, both for critical COVID-19 patients as well as those facing acute respiratory distress.
“We’ve already been using corticosteroids such as Dexamethasone and Methylprednisolone in India in moderate to severely ill Covid-19 patients as part of the Indian Health Ministry guidelines as early as March-end,” Dr Anish Nelson tells The Better India. Dr Nelson is an Emergency Physician at Dr Mehta’s Hospital, Chennai and is part of the team dealing with COVID-19 patients.
“Nonetheless, it is great to have its (Dexamethasone’s) effectiveness studied systematically through a large study like the RECOVERY trial,” says Dr Nelson.
The Reality Check
“Dexamethasone is not a one-stop cure, anti-viral, or preventive drug for COVID-19. It is, at best, an adjunct to antiviral therapy,” Dr Nelson points out. It has minimal to nil benefit for COVID-19 affected patients who are only mildly ill and not on a ventilator or other breathing support, according to the study.
More importantly, it is a highly potent corticosteroid which can weaken your immune system. Therefore, the decision to administer Dexamethasone requires careful assessment by a doctor. “Self-prescribing it would put one at more risk of reducing the initial immune response to the virus and worsening symptoms than alleviating them,” emphasised Dr Nelson.
Another thing to note is that the complete details of the study have not yet been published.
The researchers released a summary of data this Tuesday, with a peer-reviewed paper deemed to be on its way.
Reminding us of the lack of rigour and subsequent confusion around hydroxychloroquine, the well-known surgeon and author Dr Atul Gawande had this to say on Twitter, “It will be great news if dexamethasone, a cheap steroid, really does cut deaths by 1/3 in ventilated patients with COVID-19, but after all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper.”
Details of the Study on Dexamethasone
The study was conducted by RECOVERY, a large UK-based randomised controlled evaluation of COVID-19 treatments for patients hospitalised with the virus.
In this particular trial, Dexamethasone was administered to 2,100 critically ill patients on ventilator support over 10 days. The dosage was moderately low — 6 milligrams per day. The result was compared to 4,300 similarly critical patients who did not receive the steroid, but the rest of the usual care.
The study found that Dexamethasone helped critically hospitalised patients survive the worst and improved the survival rate of patients on ventilator support by 35 per cent. In patients on milder forms of breathing support, dexamethasone decreased the risk of death by 20 per cent. On the other hand, the treatment did not result in any improvement for patients who did not require respiratory support.
This is understandable as Dexamethasone’s effectiveness comes from its ability to reduce inflammation. Patients die from COVID-19 due to severe inflammation in their respiratory system. This leads to difficulty in breathing, known as Acute Respiratory Distress Syndrome (ARDS), as well as other complications.
According to the trial report, one life would be saved for every eight ventilated patients treated. On the other hand, for patients who require oxygen alone, the treatment would save one life in 25.
A Breakthrough, says the UK Government & WHO
Given the promising evidence, the UK government has sanctioned the use of Dexamethasone in the treatment of mortally ill COVID-19 patients. The World Health Organisation (WHO) is also hopeful about the drug.
“This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General in a statement. “This is great news and I congratulate the Government of the UK, the University of Oxford, and the many hospitals and patients in the UK who have contributed to this lifesaving scientific breakthrough.”
The WHO report went on to iterate: “The benefit was only seen in patients seriously ill with COVID-19, and was not observed in patients with milder disease.”
It would, therefore, be futile to use Dexamethasone for non-critical COVID-19 patients.
“It is not a cure for COVID19, but a management drug for intensive care,” reminds Dr Nelson in closing, “And most definitely not a drug for self-medication or early administration unless recommended by an intensivist or physician.”
(Edited by Saiqua Sultan)