Dexamethasone – A tentative panacea for Covid-19?

~ Written by Sonakshi Mishra

The world has been plagued with the Covid-19 pandemic for a year since its inception and this has spurred many new approaches to find a solution, one of the recent ones includes the administration of the drug- Dexamethasone, in Covid-19 patients in the UK Recovery trials.

What is Dexamethasone and why this drug?

Dexamethasone, a corticosteroid (specifically, Gluco-corticosteroid), works to decrease inflammation, which is found to be advantageous to some extent in alleviating the lethal effects of the systemic inflammatory response patients could develop when infected with Covid-19.

Oxford University’s UK Recovery clinical trial (a large, multicentre, open-label, randomised controlled trial (RCT) conducted to assess Covid-19 patients), began in April 2020, enrolling over 11,500 patients, and randomizing 2104 out of the cohort for the administration of 6 milligrams of Dexamethasone, either orally or intravenously, over 10 days. The preliminary results suggested that low doses of Dexamethasone mitigated the mortality risk by 35% in patients dependent on respiratory support. Apart from an increment in the survival chances of severely ill patients, these drugs are widely available (as oral tablets, solutions, injectable solutions) and inexpensive which allows patients to have the best of both worlds from a health and financial point of view.

But is this the cure after all?

Though this may work wonders on the severely-ailing, various health institutions hem and haw over the use of Dexamethasone owing to the aggravating effects this can have on those with severe pneumonia, those who have been afflicted by heart attacks, fungal infections or have a health history of parasite infections or tuberculosis. Not to mention, the use of this drug, in the long run, can cause cataracts or glaucoma.

Other side effects include:

• Vomiting
• Stomach upset
• Oedema
• Headache
• Anxiety
• High blood glucose levels
• High blood pressure
• Low potassium levels
• Occasional allergic reactions etc.

Moreover, this trial excluded a notable number of pediatric patients and only 1% of the patients aged above 80 years were mechanically ventilated producing uncertain results about the survival benefit for the mechanically supported patients aged over 80 years as well as for children or pregnant women. Since no significant effect was noticed on those who weren’t dependent on respiratory support, those patients shouldn’t use this drug under the aforementioned side effects that may occur.

Advice from Health institutions

The efficacy of Dexamethasone has thus only been confirmed on severely ill patients, which therefore limits its use to only these cases with the exception that it may be beneficial in cases of Covid-19 patients suffering refractory shock. Although it is prequalified by WHO, it applies only in the management of diseases associated with HIV/AIDS, not Covid-19. Its routine use has been marked unadvisable as per the guidelines issued by WHO, National Institutes of Health (NIH, USA), European Society of Intensive Care Medicine and the Society of Critical Care Medicine (ESICM/SCCM) and the National Centre for Infectious Diseases (NCID, Singapore), unless the patient was already subject to corticosteroid treatment for any other medical condition.

References and further reading:

1. https://www.medicalnewstoday.com/articles/322409#overview
2. https://www.moh.gov.sg/docs/librariesprovider5/default-document-library/dexamethasone-for-covid-19-(24-june-2020).pdf
3. https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-dexamethasone
4. https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/immunomodulators/corticosteroids/
5. https://www.channelnewsasia.com/news/singapore/covid-19-cases-singapore-steroid-treatment-dexamethasone-12858534
6. https://www.channelnewsasia.com/news/singapore/covid-19-dexamethasone-steroid-severe-cases-ncid-treatment-13202856