Why Dexamethasone for coronavirus: clinical guidelines

2024 Author: James Gerald | [email protected]. Last modified: 2023-12-17 14:00

A cheap and widely available drug called Dexamethasone may have good potential in treating patients with severe COVID-19. Does this represent a breakthrough in the fight against the COVID-19 pandemic? We will find out how dexamethasone can be used for coronavirus.

Dexamethasone helps patients in the most severe condition

Dexamethasone is a cheap and popular drug that has been used since the 1960s. It has anti-inflammatory, anti-allergic and immunosuppressive effects. It is used in the treatment of cerebral edema, in the case of anaphylactic shock, as well as in asthma, acute airway inflammation with obstruction or aspiration pneumonia. Why take it at all for coronavirus, and what is the benefit?

The study, conducted at the University of Oxford, involved over 6,000 coronavirus-infected patients. A group of 2104 patients received Dexamethasone 6 mg once a day orally or intravenously for 10 days. Another group (4321 patients) received treatment with other drugs.

As a result, 19 out of 20 patients with coronavirus recovered without hospitalization. Some required breathing assistance, such as oxygen supply or connection to a ventilator.

Among patients receiving other drugs, the highest mortality was observed among those who required mechanical ventilation (41%). Medium - observed among those who only needed oxygen, 25%. The lowest was noted among those who did not require these types of interventions.

According to a study conducted by the University of Oxford, Dexamethasone reduced mortality in ventilated patients by 1/3 and by 1/5 among patients receiving oxygen.

Patients with COVID-19 who did not have breathing problems did not see any improvement in health from taking Dexamethasone.

Potential in treating complications of coronavirus

In patients on mechanical ventilation, the risk of mortality decreased from 41 to 28%, and in those who received oxygen, from 25 to 20%. The study examining the effectiveness of Dexamethasone in the treatment of COVID-19 is part of the largest project in the world to validate the effectiveness of affordable treatments for coronavirus.

British scientists estimate that if the drug had been available in the country since the start of the coronavirus pandemic, up to 5,000 people could have been saved. Because it's cheap, the drug can also bring tremendous benefits to poorer countries that are struggling with more COVID-19 infections.

Dexamethasone is used to reduce inflammation in humans with COVID-19, with pneumonia. It also helps to reduce the negative effects of cytokine production, that is, it is able to cope with the reaction of the body trying to fight the pathology on its own. Clinical guidelines have not yet been given and are under development. Scientists need more time to determine the treatment plan for this drug and the range of patients to whom it can be prescribed.

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The drug cannot be used at home

Professor P. Horby, head of the research project, said that it is the only drug to date that significantly reduces mortality. This is a big step forward in the treatment of covid. But clinical guidelines for the use of a medication must be carefully worked out.

Another research participant, Professor M. Landray said that for every 8 ventilated patients with COVID-19, only 1. There is a clear advantage in using the drug in question, in his opinion. Dexamethasone treatment lasts up to 10 days and costs about 500 rubles on average per patient. It is a drug available all over the world. Prices in Russian pharmacies for this medicine average 98–104 rubles. per packing. The professor added that if necessary, patients in the hospital should receive it immediately. But he warned patients against using it at home.

Honored Doctor of Russia M. Kagan also drew the attention of Russians to the fact that Dexamethasone has many dangerous side effects, so only a specialist should prescribe it. Director of the Institute of Pulmonology at Assuta Hospital in Israel D. Starobin points out that the drug is unlikely to be beneficial in patients with mild form. Rather, it will be harmful. And for prevention, he, according to the expert, is not suitable.

Dexamethasone - how does the drug work?

World Health Organization (WHO) Director-General Tedros Adanom Ghebreyesus described the preliminary results of treatment with Dexamethasone, a steroidal anti-inflammatory drug, as "great news." According to him, this is the first drug found to date that can reduce mortality among severe patients affected by coronavirus.

Dexamethasone can be used to treat conditions characterized by inflammation. It soothes an overactive immune system. The medication works by mimicking the effects of cortisol, a hormone produced by the adrenal glands that controls metabolism and stress.

“At the same time, a more detailed study of the original clinical documentation for research is required,” says M. Wereschild, head of the infectious diseases center at the University Hospital Frankfurt am Main.

Preliminary results from clinical trials show that administering Dexamethasone to ventilated patients can reduce mortality by 1/3.

At the same time, the relevant data have not yet been published in any specialized journal, which would allow other experts to analyze them. According to German scientists, such an analysis should also include side effects.

The pulmonologist T. Welte of the Medical University in Hanover pointed out something else. It should be checked whether the study guarantees that the 2 patient groups are truly comparable - those who were treated with Dexamethasone and those who did not. The expert stressed that until the full text of the study, assessed by independent experts, is made public, it is impossible to judge the value of this experiment.

Pros of taking the drug

The drug can be used to control inflammation associated with many diseases. It can be skin, neurological, endocrine disorders, ulcerative colitis, multiple sclerosis, pathologies of the blood, eyes, kidneys, respiratory diseases, rheumatism.

It is usually prescribed for short-term use only. In some cases, Dexamethasone may be prescribed for a longer period of time.

The drug acts similarly to Prednisolone, but has a stronger anti-inflammatory, hormonal and metabolic effect.

Dexamethasone, given at the same dose, is less conducive to fluid retention than hydrocortisone.

Side effects from taking the drug

The most common side effects of the drug are:

• mood changes such as agitation, anxiety, and irritability;
• blurry vision;
• change in heart rate;
• swelling of the limbs due to sodium and water retention;
• increased appetite and weight gain;
• difficulty concentrating.

Severe allergic reactions have rarely been reported, but high blood pressure, slow wound healing and thinning of the skin, osteoporosis, i.e. brittle bones, low potassium levels, and problems with blood glucose may occur.

It should not be used by people with systemic fungal or viral infections. Dexamethasone can also increase the risk of infection, and its anti-inflammatory effects can mask signs of infection.

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Dexamethasone may not be suitable for people with certain conditions, such as heart failure, diabetes, osteoporosis, tuberculosis, Itsenko-Cushing's syndrome, and peptic ulcer.

Overdose can cause sodium, fluid retention, potassium loss, and weight gain. If you have been taking Dexamethasone for a long time, you must not stop taking it abruptly. The dose is reduced gradually over several weeks or months to allow the adrenal glands to return to normal secretion. Canceling Dexamethasone too quickly can cause symptoms such as bone and muscle pain. It is also important to postpone the introduction of "live vaccines" for several months after stopping treatment with Dexamethasone.

Outcomes

1. Dexamethasone, according to preliminary studies, has shown excellent results in the treatment of severe coronavirus patients with breathing problems.
2. It may be useless if the disease is milder. Also, due to the large number of side effects, it is unlikely to be recommended for prevention purposes.
3. Prescribing a medication requires careful selection of the dose, and therefore you cannot buy it yourself and prescribe it. It may be dangerous.