Image is for representational use only. | Image Courtesy: Nature
A randomised and controlled clinical study conducted in the UK has found that the readily available steroid drug, Dexamethasone, could be a game changer in treating critically ill COVID-19 patients. It found that administering dexamethasone could reduce deaths by one-third in patients under ventilators, the press statement of the study said on June 16.
The utility of dexamethasone came out of the RECOVERY (Randomised Evaluation of COVid-19 therapy) project. Set up in March, RECOVERY is one of the world’s largest randomised controlled trials for treatment of COVID-19 patients.
In the dexamethasone study, 2,104 patients received the steroid in a dose of 6 mg once per day for 10 days. The patients who received dexamethasone were compared with a set of 4,321 patients that were given usual care, without the drug.
“Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%). 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)”—reads the press statement of RECOVERY.
The results indicate that out of eight patients under ventilation, one death could be prevented and among those receiving oxygen but not in ventilation, the reduction in risk of dying is by 20%. However, the steroid was found to have no effect on patients with mild symptoms—not receiving oxygen or ventilation.
The UK government, shortly after the announcement of the results, hurriedly announced that it has authorised the use of dexamethasone for treating COVID-19 patients with severity, both receiving oxygen and ventilation.
Concerns about Using Steroids in COVID-19 Patients
But, treatment with steroids in the case of viral respiratory diseases like COVID-19 has been controversial. The previous cases of steroid treatment in SARS and MERS were inconclusive. The WHO has also cautioned against treatment of novel coronavirus infections with steroids. These concerns arise from the fact that steroids suppress the immune system. An active immune system is required to fight the virus.
Nevertheless, dexamethasone’s widespread availability and its cheap cost, along with the promising results from steroid studies in previous outbreaks had led the RECOVERY investigators to include the steroid in their trial, according to Peter Horby, the chief investigator of the trial and an infectious disease specialist of Oxford University.
In severe COVID-19 patients, an aberrant over reactive immune response is what has been seen. In this situation, a suppression of the immune system could be a relief sometimes, but a major shutdown of it cannot be afforded. The doses at which dexamethasone is tried are very nominal and it is suggestive, if we have to believe the findings of the trial, that the benefits of the steroid could outweigh the harm, potential deaths due to lung failure.
What is Dexamethasone?
Dexamethasone belongs to a class of drug called the corticosteroids. To understand corticosteroids, one needs to know what is a steroid. It is a man-made chemical that resembles a hormone in its structure and function. Corticosteroids are more specialised, it is a chemical that resembles cortisol, the hormone produced by the adrenal glands.
Corticosteroids can function in a similar fashion as that of cortisol. They behave like transcription factor, which is a protein that binds to a specific location in the DNA and by doing so can influence the expression of a gene—either suppressing or expressing it.
Dexamethasone is widely used in various kinds of inflammatory diseases, in order to suppress the inflammation. Arthritis, allergic reactions, skin and eye conditions of various types are some of the commonly used disorders that dexamethasone is used for.