COVID-19: An old drug for a new scourge

A positive note was sounded earlier this week with the announcement of a group in the UK that the drug dexamethasone, a steroid, had been showing beneficial results in patients who were severely ill and on ventilators as a result of COVID-19.

According to a June 16 article in The New York Times, British scientists at the University of Oxford said that dexamethasone reduced the numbers of deaths from patients who were severely ill with the virus. If this claim pans out, this would be the first such treatment to have a beneficial effect. 

Dexamethasone is a cheap, tried-and-true treatment for numerous inflammatory diseases such as arthritis, blood disorders, renal diseases, respiratory disorders, and ocular disorders, to name just a few.

According to The New York Times report, “In severe cases, the virus directly attacks cells lining the patient’s airways and lungs. But the infection also can prompt an overwhelming immune reaction that is just as harmful.

Three-quarters of hospitalized COVID-19 patients receive some form of oxygen. The drug appears to reduce inflammation caused by the immune system, protecting the tissues.”

The benefits of the drug were seen in a randomized controlled study led by Peter Horby, professor of emerging infectious diseases, University of Oxford.

During the study, about 2,100 severely ill patient with COVID-19 received once-daily low doses of dexamethasone administered orally or intravenously. The results were compared with 4,300 patients treated with received the usual care.

In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

“Dexamethasone is the first drug to be shown to improve survival in COVID-19,” according to Dr. Horby. “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment.”

This benefit of the drug is so important that Dr. Horby suggested that it should become the standard of care for these patients. The drug is readily available and inexpensive.

The investigators stopped the study early because of the obvious benefits they were seeing. However, the drug was not beneficial for moderately ill patients who were not receiving oxygen.

An earlier smaller trial of dexamethasone in Spain found that the drug may reduce the time that patients spent on ventilators and reduce the number of deaths.