Is Dexamethasone the COVID-19 Cure We've Been Looking For?
Since the 1960s, dexamethasone has been the inexpensive corticosteroid of choice to treat symptoms associated with respiratory viruses. Dexamethasone is widely available and known for relieving inflammation and inflammatory diseases like arthritis, asthma and even some types of cancer. New research shows that this drug could also be a life-saving treatment for COVID-19, the disease caused by the novel coronavirus. Although testing, research and trials are still underway, preliminary findings indicate that dexamethasone may be a promising option for critically ill COVID-19 patients due to its anti-inflammatory and immunosuppressive effects. Here’s where the research stands so far.
What Is Dexamethasone?
Dexamethasone is a corticosteroid that doctors primarily prescribe due to its anti-inflammatory effects. This drug has been used to treat conditions such as arthritis, asthma, severe allergies, inflammatory bowel diseases and multiple sclerosis, and it appears to be particularly effective on patients’ respiratory systems. COVID-19 is a lung disease, and the most common complications include symptoms related to the lungs and damage to the respiratory system due to inflammation. Immune responses have caused many symptomatic COVID-19 patients to experience pain in their lungs, trouble breathing and other respiratory problems, including further complications like pneumonia.
Dexamethasone and other corticosteroids have long been prescribed to treat respiratory diseases. Some lung illnesses, including COVID-19, cause the lungs to become inflamed, which makes it difficult to breathe. COVID-19 can also cause injury and scarring to the lungs, and these effects result in further inflammation. Dexamethasone and other corticosteroid drugs work by preventing a person’s body from producing the natural chemicals that cause inflammation, in turn leading to a decrease in tissue damage and a reduction in symptoms. COVID-19 and other inflammatory illnesses can put lungs and other organs at risk for critical damage, but corticosteroids can be both organ-saving and life-saving treatments, depending on the severity of the disease.
One of the biggest perks of dexamethasone, aside from its organ-sparing effects, is its affordability. According to the BBC, the dosage needed to treat COVID-19 patients costs around $6.79 per day. That would cost roughly $44.00 per patient over the course of the treatment. This drug is widely available, is relatively inexpensive and can be produced on a large scale if necessary. If this treatment proves effective, accessibility would not be as much of a barrier to patients’ ability to receive dexamethasone. The same may not be true for other more expensive treatments currently in use.
Can Dexamethasone Reduce Chances of Death?
The medical community already knows that corticosteroid drugs are effective at preventing organ damage due to inflammation and, in some cases, at preventing death as well — but how well does dexamethasone in particular function for treating COVID-19? Research is currently ongoing, but initial results look promising.
One of the world’s largest COVID-19 trials — the Randomized Evaluation of COVID-19 Therapy, or RECOVERY — is being conducted by the University of Oxford. During the trial, over 11,500 COVID-19 patients were studied in 175 hospitals across the United Kingdom to test the effectiveness of dexamethasone and several other drugs in children and adults. Of the 11,500 patients who initially participated, 2,104 were selected at random to take dexamethasone and were treated with 6mg of the corticosteroid either orally or via IV line for 10 days.
In this initial study, the 2,104 patients were compared to 4,321 patients who received the typical care protocol for COVID-19. Researchers found a decrease in the death rate in one-third of the patients on dexamethasone. The trial also resulted in fewer deaths for ventilated patients compared to those who received typical treatment. One-fifth of these patients also didn’t go on to need oxygen. With the number of deaths that were shown to have decreased in the study, the results could be promising for patients worldwide. One of the University of Oxford’s chief investigators discussed how impactful this treatment could be due to its low price and availability, considering the fact that dexamethasone is widely accessible worldwide.
So far, initial findings of RECOVERY have indicated that dexamethasone may reduce the risk of death for patients on ventilators and on oxygen — some of the highest-risk groups. Although these results appear favorable, medical professionals and researchers still need to learn more about dexamethasone’s role in alleviating symptoms of COVID-19 and see if RECOVERY’s findings are replicable.
Dexamethasone’s Emerging Role in Treating COVID-19
The primary treatment plan for COVID-19 has been similar to that for viral pneumonia. This respiratory disease often responds well to anti-inflammatory medications as well as antivirals, which inhibit a virus’ ability to replicate. Remdesivir is one antiviral drug that has been shown to slow down the replication and growth of the coronavirus and possibly limit recovery times. This drug hasn’t been approved for use globally — but it has been authorized for emergency usage in the treatment of COVID-19. However, remdesivir is more complicated to administer than dexamethasone, but the two drugs in combination may provide complementary effects by amplifying each other’s efficacy. While the remdesivir is preventing the virus from reproducing and spreading quickly, the dexamethasone could have more time to lessen harmful inflammation.
In addition to lessening inflammation, corticosteroid drugs also help to curb an overactive immune system response. To a degree, inflammation itself is an immune response that can help a person’s body keep infections from spreading, but when it worsens in severity, it does more harm than good. Immunosuppression — to a degree — is another area in which dexamethasone has been effective because it keeps overactive immune systems from creating too much inflammation. A hyper-immunological response like this to COVID-19 has been fatal for many patients.
The treatment of COVID-19 using dexamethasone isn’t clear cut. Think of dexamethasone usage like the story of Goldilocks. Too much can cause deadly harm, while too little won’t relieve enough inflammation to make a difference in a patient’s symptoms. While physicians want to slow down a patient’s immune system, they also need this system to help fight the coronavirus. Finding the right balance is key. Previous studies that were done on SARS showed that corticosteroids were not particularly helpful in treatments. This brings up the question of whether corticosteroids will be as helpful to COVID-19 patients as the initial results indicate.
Dexamethasone’s Potential Side Effects Aren’t Without Risk
With any form of treatment, there are almost always potential side effects. When it comes to dexamethasone in particular, more studies need to take place to determine the likelihood of adverse reactions. Some SARS patients who took corticosteroids developed long-term health conditions such as osteoporosis, which appears to correlate with the use of corticosteroids for treatment, and this may be the case with using dexamethasone to treat COVID-19. Corticosteroids also have commonly known side effects, but the potential life-saving benefits of these drugs often outweigh the discomfort and risk many of those side effects pose.
Because dexamethasone suppresses immune system function, it can also lead to an increased risk for patients to develop bacterial and other infections, which their bodies may then have a more difficult time combating. Already, some critically ill COVID-19 patients on ventilators have had difficulty fighting bacterial infections while hospitalized. Infections can pose serious risks to COVID-19 patients and lead to other complications. In patients who have hypertension or diabetes, corticosteroids can cause several problems by increasing glucose levels, resulting in the need for glucose management and insulin. This hyperglycemia (high blood sugar levels) can also occur in people who have never been diagnosed as diabetic before.
Other Treatment Options May Show Promise, Too
For people of color, the virus has been especially devastating. However, the drug tocilizumab, which is typically prescribed for rheumatoid arthritis, has been tested and the results show promise. When control groups for age were used, Latinx and Black patients had a better survival rate than white COVID-19 patients while using this drug. More tests and findings need to be performed and gathered, but this has been a welcome breakthrough.
When a patient is likely to have side effects or complications from using a corticosteroid treatment, remdesivir can sometimes be an effective alternative. It also has the potential to get people out of the hospital faster and may improve survival, but again, research to determine this likelihood is still ongoing. In anticipation, the U.S. has bought more than 500,000 doses of remdesivir, which represents more than 90% of what the medication’s production company is able to make through July, August and September of 2020.
Convalescent plasma has also been beneficial to COVID-19 patients in some cases. This treatment involves giving people who currently have COVID-19 transfusions of plasma from people who have recovered from COVID-19. Recovered patients have antibodies in their blood, and these proteins may help people with severe cases of COVID-19 fight off the virus better or experience fewer complications. Convalescent plasma therapy isn’t as widely available, so the wait times can be problematic for patients with urgent cases. Doctors also don’t yet know whether this treatment is effective — although it has been beneficial to COVID-19 patients in preliminary trials — and researchers are still evaluating the results of this therapy.
Despite Promising Initial Results, More Research Is Necessary
One of the most exciting aspects of using dexamethasone is that it is so widely available and affordable. If this treatment is proven effective, it could be used worldwide to help COVID-19 patients recover, particularly until a vaccine is developed and deployed. More testing and research trials still need to be conducted to determine whether dexamethasone has widespread applications and is truly effective for treating COVID-19. Another area that still needs further study is how the drug’s effects compare to other available treatments such as remdesivir, convalescent plasma and tocilizumab. These results are especially important for people who may experience corticosteroid-related complications.
The results are also most promising for patients who have already been hospitalized, and a drug that could treat the virus earlier would be ideal. While there is still much that remains unknown about the novel coronavirus, dexamethasone has been shown to be effective on hospitalized patients — and that is a positive step forward for researchers.