Patients hospitalized with COVID-19COVID-19 \ ˈkō-vid-nīn-ˈtēn : a mild to severe respiratory illness that is caused by a coronavirus (Severe acute respiratory syndrome coronavirus 2 of the genus Betacoronavirus), is transmitted chiefly by contact with infectious material (such as respiratory droplets), and is characterized especially by fever, cough, and shortness of breath and may progress to pneumonia and respiratory failure. 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 ventilatorventilator ven·ti·la·tor | \ ˈven-tə-ˌlā-tər : a machine that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently.. 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 virusvirus vi·rus | \ ˈvī-rəs : a disease-causing agent that is too tiny to be seen by the ordinary microscope, that may be a living organism or may be a very special kind of protein molecule, and that can only multiply when inside the cell of an organism . The low-dose steroid treatment is part of the world’s biggest trial testing existing treatments to see if they also work for coronaviruscoronavirus co·ro·na·vi·rus : any of a family (Coronaviridae) of single-stranded RNA viruses that have a lipid envelope studded with club-shaped projections, infect birds and many mammals including humans, and include the causative agents of MERS, SARS, and COVID-19.
The drug is already used to reduce inflammation in a range of conditions, including arthritis, asthma and some immune systemimmune system : the bodily system that protects the body from foreign substances, cells, and tissues by producing the immune response and that includes especially the thymus, spleen, lymph nodes, special deposits of lymphoid tissue (as in the gastrointestinal tract and bone marrow), macrophages, lymphocytes including the B cells and T cells, and antibodies. 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 Remdesivirremdesivir Remdesivir (development code GS-5734) is a novel antiviral drug in the class of nucleotide analogs. Remdesivir is an adenosine analogue, which incorporates into nascent viral RNA chains and causes their pre-mature termination. It was developed by Gilead Sciences as a treatment for Ebola virus disease and Marburg virus infections, though it subsequently was found to show antiviral activity against other single stranded RNA viruses such as respiratory syncytial virus, Junin virus, Lassa fever virus, Nipah virus, Hendra virus, and the coronaviruses (including MERS and SARS viruses).
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 infectioninfection in·fec·tion | \ in-ˈfek-shən a : the state produced by the establishment of one or more pathogenic agents (such as a bacteria, protozoans, or viruses) in or on the body of a suitable host b : a disease resulting from 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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