Steroid treatment Dexamethasone Reduces COVID-19 Mortality

Steroid treatment Dexamethasone Reduces COVID-19 Mortality

Patients hospitalized with COVID-19 who have high levels of inflammation may benefit significantly from dexamethasone and other steroids, researchers say. A dexamethasone RECOVERY (Randomized Evaluation of COVid-19 thERapY) trial in hospitalized patients with COVID-19 showed that patients who were randomized to receive dexamethasone had a lower mortality rate than those who received standard care. Dexamethasone reduced COVID-19 deaths by 1/3 in ventilated patients and by 1/5 in patients receiving oxygen.

The treatment is not recommended for treating mild COVID-19 symptoms, and it did not help COVID-19 patients who were not on oxygen or a ventilator. The treatment was shown to reduce early inflammation required to kill virus-increased viral load in the lungs. Some scientists have called dexamethasone a major breakthrough in COVID-19 treatment, as it is the first therapeutic agent to improve survival rates.

NIH, WHO Recommend Dexamethasone Treatment

The National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel recommends using dexamethasone at a dose of 6 mg per day for up to 10 days for the treatment of COVID-19 in patients who are mechanically ventilated (AI) and in patients who require supplemental oxygen but who are not mechanically ventilated (BI). The treatment may be risky for patients with mild symptoms, or those who are not receiving respiratory support or supplemental oxygen.

The RECOVERY study recorded deaths during 28 days after starting dexamethasone treatment. Preliminary results indicate that, compared with usual care, dexamethasone:

  • Reduced mortality by about 35% in patients on invasive mechanical ventilation
  • Reduced mortality by about 20% in patients receiving oxygen without invasive ventilation
  • Did not reduce death in patients who were not receiving oxygen therapy.

The World Health Organization (WHO) is in the process of updating treatment guidelines to include dexamethasone or other steroids. Japan’s health ministry has approved dexamethasone, an inexpensive and widely used steroid, as a second treatment of COVID-19 after a trial in Britain showed the drug reduced death rates in hospitalized patients.

Use of anti-inflammatory drug dexamethasone also was approved by the National Health System in the UK’s fight against the deadly virus. The low-dose steroid treatment is part of the world’s biggest trial testing existing treatments to see if they also work for coronavirus.

The drug is already used to reduce inflammation in a range of conditions, including arthritis, asthma and some immune system and hormone disorders. It appears to help stop some of the damage that can happen when the body’s immune system goes into overdrive, or cytokine storms, as it tries to fight off coronavirus.

For further details and information on Cytokine Storm Syndrome (CSS) in COVID-19, please visit this post, “Researchers tie Chronic Inflammation to Severe COVID-19 Disease.”

The full results of the large randomized clinical trial released earlier this month in the New England Journal of Medicine confirmed the benefits of dexamethasone for people with advanced or moderate disease.

Anti-Viral Medication Remdesivir approved as COVID-19 Treatment

In May, the FDA and NIH approved anti-viral drug remdesivir for treatment of hospitalized COVID-19 patients. The drug, which is being studied in clinical trials globally, is believed to decrease viral RNA production in COVID-19 disease, thus limiting replication and proliferation of the infection.

Remdesivir clinical trials found that the drug only significantly helped patients who needed supplemental oxygen. There was no marked benefit for patients who were healthier or those that were sicker, requiring a ventilator or heart-lung bypass machine. The study goes on to warn that “given high mortality despite the use of Remdesivir, it is clear that treatment with an antiviral drug alone is not likely to be sufficient.”

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