Dexamethasone, the first drug proven to have saved the lives of novel Coronavirus (COVID-19) patients, probably should not be given to people in the initial stages of the illness, when they do not need help to breathe, the final results of an extensive clinical test show.
Dexamethasone is the only medication, along with the antiviral remdesivir, that has proved to be effective against COVID-19 following rigorous clinical tests that compared their effects with those of other treatments. Remdesivir reduces hospitalisation time but not mortality. Other drugs, like hydrochloroquine, have failed to show any effect.
As a result, dexamethasone and remdesivir have been adopted in international therapeutic recommendations and their production has been stepped up. The low cost of dexamethasone, a corticoid (anti-inflammatory drug) that has been around for a long time now, should facilitate its use worldwide.
Recovery Clinical Trials in the United Kingdom had announced in a press release on 16 June that, compared to the standard treatments, dexamethasone reduced deaths by a third in patients on mechanical ventilation, and by a fifth in patients receiving oxygen without being attached to artificial respiratory machines.
The complete results of the clinical test, done on 15% of patients hospitalised for COVID-19 in Britain, were published on Friday in the New England Journal of Medicine. They confirm and expand on the results that had been announced in June.
The tests show that 29.3% of patients on ventilation to whom a daily dose of 6 mg of dexamethasone was administered intravenously died within 28 days, as against a death rate of 41% for patients of a comparable age receiving standard COVID care.
The reduction was less for people receiving oxygen in a non-invasive manner (23.3% versus 26.2%).
The results were best in people who had shown symptoms for seven days or more.
The data confirms that dexamethasone should not be administered to patients in the early stages of the illness, which seems logical since steroids reduce the body’s immune response. It is only when the illness progresses that hyperactivity of the immune system becomes apparent in the patient, causing severe inflammation in various organs, which is often the cause of death.