Dexamethasone for COVID-19 infection treatment
Dexamethasone : the first life-saving drug for COVID-19 patients
Clinical trials make it possible to evaluate whether a treatment improves outcomes. Developing a hypothesis, for example if treatment A is better than standard treatment B, clinical trials enable understanding of the role of an intervention in improving patient care. In the current search for a successful treatment against COVID-19, ongoing multiple clinical trials have started to make a difference, such as the Recovery clinical trial on dexamethasone, which has given a definitive verdict on the use of corticosteroids during COVID-19.
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Dexamethasone is a corticosteroid used in a wide range of conditions for its anti-inflammatory and immunosuppressive effects.
It was tested in hospitalized patients with COVID-19 in the United Kingdom’s national clinical trial RECOVERY and was found to have benefits for critically ill patients.
Coronavirus disease (COVID-19): Dexamethasone
Recommendation 1:
WHO strongly recommends that corticosteroids (i.e. dexamethasone, hydrocortisone or prednisone) be given orally or intravenously for the treatment of patients with severe and critical COVID-19.
Recommendation 2:
WHO advises against the use of corticosteroids in the treatment of patients with non-severe COVID-19, unless the patient is already taking this medication for another condition.
Coronavirus disease (COVID-19): Dexamethasone
Dexamethasone is generally safe. It presents a favourable benefit-risk profile, particularly in patients with severe forms of pneumonia, while the benefit is less prominent in patients with non-severe pneumonia. As the treatment is short, even at high doses, corticosteroids are not associated with serious side effects. Potentially higher blood glucose levels (hyperglycaemia) are temporary.
Prolonged use (I.e., used for more than two weeks) may be associated with adverse events such as glaucoma, cataract, fluid retention, hypertension, psychological effects (e.g., mood swings, memory issues, confusion or irritation), weight gain, or increased risk of infections and osteoporosis.
To reiterate: All these adverse events are not associated with short term use (with the exception of hyperglycaemia that can worsen diabetes).
Coronavirus disease (COVID-19): Dexamethasone
The current interim guidance from WHO on clinical management of severe acute respiratory infection when COVID-19 infection is suspected advises against the use of corticosteroids unless indicated for another reason.
This guidance is based on several systematic reviews that cite lack of effectiveness and possible harm from routine treatment with corticosteroids for viral pneumonia or acute respiratory distress syndrome.
In patients with severe COVID-19 who required oxygen support, using dexamethasone 6 mg daily was administered either orally or intravenously for up to 10 days and reduced mortality at 28 days. The benefit of dexamethasone was most apparent in hospitalized patients who were mechanically ventilated.
Corticosteroids | COVID-19 Treatment Guidelines
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