We get all excited when news about a development on COVID treatment is reported. What more when someone like the United Kingdom’s Prime Minister himself, Boris Johnson, announces the breakthrough to the whole world? We’re referring to the low-cost dexamethasone being touted a “chink of light” against the pandemic. The Director General of the World Health Organization’s (WHO), Dr. Tedros Adhanom Ghebreyesus, likewise welcomes this “lifesaving scientific breakthrough.”
But what really is this drug and how does it help save the lives of COVID-19 patients? What did the researchers find out in the preliminary clinical trial?
Dexamethasone actually isn’t a new drug. According to the WHO, it’s “a steroid that has been used since the 1960s to reduce inflammation in a range of conditions, including inflammatory disorders and certain cancers.”
Corticosteroids (often known as steroids) like dexamethasone treat conditions including arthritis, asthma, allergic reactions, and autoimmune diseases such as lupus, sarcoidosis, or inflammatory bowel disease, according to the Centers for Disease Control and Prevention (CDC).
It reduces mortality rate for the critically ill COVID patient
The initial clinical trial conducted by the Oxford University in the UK shows that dexamethasone can be lifesaving for patients who are critically ill with COVID-19.
For patients on ventilators, the treatment was shown to reduce mortality by about one-third, and for patients requiring only oxygen, mortality was cut by about one-fifth, according to preliminary findings shared with WHO. The organization clarified though that the “benefit was only seen in patients seriously ill with COVID-19, and was not observed in patients with milder disease.”
The randomized trial was part of RECOVERY, or the Randomised Evaluation of COVid-19 therapy trial, which was launched in March to test a range of potential treatments for COVID-19, including low-dose dexamethasone.
“It involved a total of 2,104 patients. They were to receive dexamethasone 6mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomized to usual care alone,” noted a news release issued by Oxford University. “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%).”
Based on these results, daily doses of dexamethasone could prevent 1 in 8 ventilated patient deaths and save 1 out of every 25 patients requiring oxygen alone, the team said.
The trial included a control group of 4,000 patients who did not receive the treatment.
Peter Horby, Professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, and one of the Chief Investigators for the trial, said “dexamethasone is the first drug to be shown to improve survival in COVID-19.” He affirmed, “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.”
Steroids can make you prone to COVID-19
In an interview with ANC, Dr. Edsel Maurice T. Salvaña, the director of the Institute of Molecular Biology and Biotechnology, explained that dexamethasone is “very useful for people with lung problems” because “part of the problem of COVID-19 is severe lung inflammation or pamamaga ng baga.” He said it is most likely saving lives because it decreases the lung inflammation, allowing the patient to breathe better.
He said the drug is already being used in the country. “Actually, it’s part of the protocol. [It’s administered to] some people who have lung problems, particularly an acute respiratory distress syndrome (ARDS), which can be seen in patients with COVID-19. A subset of those patients do respond to steroids,” he said.
“We use short doses of corticosteroids including dexamethasone and we do see survival benefits. This is not a surprising finding and that is why it is being used in a clinical trial,” he added.
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He emphasized though that using steroids has its caveats—while it decreases inflammation, it also weakens the immune system. “This is what we call an immune modulator. It’s not an anti-viral, it doesn’t kill the virus. It’s not something that can prevent COVID-19 from coming in. On the contrary, based on its mechanism, it might actually increase your risk of COVID-19 if you take it and you don’t have the disease,” he explained.
Dr. Salvaña stressed in a Facebook post, “DO NOT take steroids for COVID-19 prevention or treatment without proper medical supervision. Steroids lower your immune response and can have long-term health consequences if taken haphazardly. This is why a clinical trial was needed to see if there is a beneficial effect. There is NO evidence [that] steroids are useful for preventing COVID-19 and they don't work unless you have bad enough COVID-19 that you need oxygen.”
He noted that the study is “not yet a peer-reviewed paper so we need to take the findings with a grain of salt, because many papers have had to be modified after problems were found during the peer review process.”
“I think overall it’s good news. It really brings us news na may laban tayo,” he told ANC. “We have a drug that can affect mortality, decrease the risk of dying but at the same time we have to be cautious because we still know very, very little about this virus. While we know it’s good news, there’s always that issue where people may not use this properly and could end up hurting themselves."