This week, there has been a major breakthrough in Covid-19 treatment. Dexamethasone has been heralded as a life-saving drug. In this article, we will break down what this drug does, who it is for and possible side effects.
What is Dexamethasone?
Dexamethasone (C22H29FO5) is a low-dose steroid treatment. It is a cheap and widely available drug. The drug is part of the world’s biggest Covid-19 trial, testing existing treatments to see if they also work for coronavirus.
Dexamethasone as been in use since the early 1960s. It treats a wide range of conditions including inflammation, asthma, arthritis and some skin conditions.
The UK government has 200,000 courses of the drug in its stockpile and says the NHS will make this dexamethasone available to all patients who would benefit from it.
For covid-19 patients, the drug will be intravenous in intensive care and in tablet form for less seriously ill patients.
Who does it work for?
Dexamethasone has been found to be highly effective for those seriously ill with covid-19. It is not for those with a mild illness. It is most effective for those on ventilators, where is was shown to cut the number of people dying by a third. For those just requiring oxygen treatment in hospital, it cut deaths by a fifth.
And it could be of huge benefit in poorer countries with high numbers of Covid-19 patients. The drug is cheaper in those countries, making it a great cost-effective solution.
Dexamethasone does not appear to help people with milder symptoms of coronavirus who do not need medical help with their breathing.
In the trial at Oxford University, about 2,000 hospital patients took dexamethasone and more than 4,000 did not.
For patients on ventilators, it cut the risk of death from 40% to 28%.
For patients needing oxygen, it cut the risk of death from 25% to 20%.
Chief investigator Prof Peter Horby said: “This is the only drug so far that has been shown to reduce mortality – and it reduces it significantly. It’s a major breakthrough.”
The UK trial was able to stop because of such significant results.
Lead researcher Prof Martin Landray said the findings suggest that it could save one life in:
- every eight patients on a ventilator
- every 20-25 needing oxygen
It appears to help stop some of the damage that can happen when the body’s immune system goes into overdrive as it tries to fight off coronavirus. This over-reaction, a cytokine storm, can be deadly.
Other drugs being tested
The Recovery Trial, running since March, also is investigating the malaria drug hydroxychloroquine. It has subsequently been ditched amid concerns it increases fatalities and heart problems.
The antiviral drug Remdesivir has been shown to reduce the duration of coronavirus symptoms from 15 days to 11. However, the evidence was not strong enough to show whether it will reduce mortality. Unlike dexamethasone, Remdesivir is a new drug with limited supplies and an unknown price tag.
What are the potential side effects of this covid-19 treatment?
This is a well-established drug and has been generically available for many years. It is generally well-tolerated. However, with all medication, there are possible side-effects.
There is always a risk-benefit ratio when assessing treatment and in this situation. In this situation when someone is extremely ill and on a ventilator, the following possible side-effects are of less concern. Not all patients are likely to experience possible side-effects.
The UK’s National Institute for Health and Care Excellence (NICE) lists the following conditions as common or very common side-effects of all corticosteroids, including dexamethasone:
- Behaviour abnormalities
- Cognitive impairment
- Cushing’s syndrome; electrolyte imbalance
- Fluid retention
- Menstrual cycle irregularities
- Skin reactions
- Sleep disorders
- Weight increase
More uncommon side-effects include bigger appetite, eye disorders, heart failure, seizure, tuberculosis reactivation and vertigo.
Further warnings around side-effects centre on risks associated with long therapy with corticosteroids, which is unlikely to be the case with patients suffering from Covid-19.
However, those taking corticosteroids should take special care to avoid exposure to chicken pox – unless they have previously had the illness – and measles, both of which are may place a patient at greater risk.
The NICE guidance also says systemic corticosteroids, particularly in high doses, could link to “psychiatric reactions including euphoria, insomnia, irritability, mood lability, suicidal thoughts, and behavioural disturbances”.
What does this mean for beating the pandemic?
From the trial, about 19 out of 20 patients with coronavirus recover without being going to hospital. Bringing this drug to the public would take a huge amount of pressure off the NHS.
Prime Minister Boris Johnson says there was a genuine case to celebrate “a remarkable British scientific achievement”. He adds “We have taken steps to ensure we have enough supplies, even in the event of a second peak.”
Researcher Prof Landrays says “The treatment is up to 10 days of dexamethasone and it costs about £5 per patient. So essentially it costs £35 to save a life. This is a drug that is globally available. When appropriate, hospital patients should now take it without delay.”
People should not go out and buy it to take at home.
This major breakthrough is something to celebrate. It means patients across the world can benefit from this cheap and easily accessible drug immediately.
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