COVID-19: Low-cost Drug Dexamethasone Said To Reduce Death Risk in Critically Ill Coronavirus Patients

The clinical use of Dexamethasone—a basic and low-cost corticosteroid—has been found to be the first drug in reducing deaths of critically ill COVID-19 patients.

This is hailed as a ‘major breakthrough’ in the treatment of the coronavirus, considering that there is no effective treatment or vaccine currently. 

Reduced Risk of COVID-19 Death: A “Major Breakthrough”

Based on the preliminary results of the large trial conducted by Oxford University researchers, the treatment is said to have reduced mortality by one third for patients on ventilators, according to a World Health Organisation (WHO) news release on 16 June 2020.

The benefits apply to only patients with severe respiratory complications and not observed in milder cases who did not require respiratory support.

On the other hand, mortality was said to be reduced by about one fifth for patients requiring only oxygen.

Treating around 8 ventilated patients or around 25 patients requiring oxygen alone would prevent one death, according to the chief investigators of the study in a statement.  

For that, it could cost less than £50 (S$88), according to Prof Martin Landray, an Oxford University professor co-leading the recovery trial as said in an online briefing.

“It’s going to be very hard for any drug really to replace this.”In addition, dexamethasone can also be produced in large dosages by generic manufacturers such as in India.

“Dexamethasone should now become standard of care in these patients”

In light of the visible benefits to severely ill COVID-19 patients, one of the Chief Investigators for the trial called for the use dexamethasone to immediately become the standard care in patients.

“Dexamethasone is the first drug to be shown to improve survival in COVID-19. 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,” said Peter Horby, Professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford.

Even so, further data analysis will still be required for the “full data analysis in the coming days”.

WHO also said it will also update its clinical guidance on how and when to administer dexamethasone in COVID-19 treatment.

Still, the public are advised not to purchase and self-administer the drug at home.

How Dexamethasone is Used and its Benefits

Dexamethasone is already used as anti-inflammatory medication in a range of other conditions such as arthritis, asthma and in some skin conditions. It helps relieve swelling, redness, itching, and allergic reactions.

It also has many uses for the treatment of some types of cancer.

Important note: While dexamethasone comes in the form of tablet, elixir or solution, it has to be prescribed by your doctor.

Here are some of its uses:

• Treat certain kind of conditions: autoimmune diseases (e.g. rheumatoid arthritis), skin conditions, asthma and other lung conditions
• Various cancer treatment e.g. leukaemia, lymphoma, and multiple myeloma
• Treat nausea and vomiting – associated with the use of chemotherapy drugs
• Decrease swelling (oedema) – associated with tumours of the spine and brain 
• Treat eye inflammation
• Treat or prevent allergic reactions
• Stimulate appetite problems of cancer patients
• Used to replace steroids in cases of adrenal insufficiency (where the adrenal glands do not produce enough hormones)

What are the Dexamethasone Side Effects? As with many treatments, there are also dexamethasone side effects in its usage, and they could vary from individuals. However, it is said that many people using this medication do not experience serious side effects.

Side effects could include: 

• Stomach upset
• Headache
• Dizziness
• Menstrual changes
• Trouble sleeping
• Increased appetite
• Weight gain

If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

And in cases where you experience these unlikely symptoms—which could be serious—notify your doctor immediately:

• Fever
• Persistent sore throat
• Bone or joint pain
• Increased thirst or urination
• Fast, slow or irregular heartbeat
• Eye pain or pressure, vision problems
• Heartburn
• Puffy face
• Swelling of the ankles or feet
• Symptoms of stomach or intestinal bleeding (e.g. stomach or abdominal pain)
• Black/tarry stools
• Vomit that looks like coffee grounds
• Pain, redness, swelling of arms or legs
• Tiredness
• Mental or mood changes (e.g. depression, mood swings, agitation)
• Unusual hair or skin growth
• Muscle pain or cramps, weakness
• Easy bruising or bleeding
• Slow wound healing, thinning skin
• Seizures

What are the Precautions?

There are certain precautions that patients can take to reduce the risk of infections, which are highlighted below:

• Inform your doctor of your current medications before starting dexamethasone treatment
  • This includes prescription, over-the-counter, vitamins, herbal remedies, etc.
  • Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
• Refrain from taking any kind of immunisation or vaccination during dexamethasone treatment 
• Do not discontinue dexamethasone abruptly or change the dosage on your own – unless directed by your healthcare provider
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment
  • This drug should only be used if clearly needed during pregnancy, and if the potential benefit justifies the potential risk to the foetus. Till date, there are insufficient studies done on humans to ascertain how the drug might affect the foetus.
• Do not conceive a child while taking dexamethasone – applicable to both men and women
• Discuss with your doctor when you may safely become pregnant or conceive a child after therapy
• Do not breastfeed while taking this medication 
  • There is a possible transmission into breast milk, leading to undesirable effects on a nursing infant.

Source: WebMD, Chemocare

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