COVID-19: Dexamethasone

Table of Contents

• Brief Overview
• About Dexamethasone
• In Treatment of COVID-19
• About the Trial
• Potential problems/ Shortcoming

Brief Overview

• In a recent press release by Scientists involved with the RECOVERY (short for ‘Randomised Evaluation of COVID-19 Therapy’) trial, from the Oxford University, had claimed that a Drug named Dexamethasone can potentially cut the mortality rate in patients by a third (-33%)
• The trail data seemed to suggest a 1/3^rd reduction in mortality in patients with ventilator support and a 1/5^th reduction in patients requiring oxygen support.
• It’s important to note that their announcement was preliminary in nature: the study’s underlying data isn’t available yet for independent verification.

About Dexamethasone

• Dexamethasone is not a recently discovered/systhesised drug.
• It is classified as a corticosteroid hormone (glucocorticoid). Glucocorticoids have anti-inflammatory activity.
• It decreases the body’s natural defensive response and reduces symptoms such as swelling and allergic-type reactions.
• Common indications that suggest its use include conditions such as arthritis, blood/hormone/immune system disorders, allergic reactions, breathing problems and etc. It is also used as a test for an adrenal gland disorder (Cushing’s syndrome).

In Treatment of COVID-19

• In COVID-19 patients, dexamethasone serves to dampen the body’s immune response when it becomes too aggressive to control by other means.
• An inflammation refers to the body’s immune response to an invading pathogen and an inflammatory reaction is vital for the body to clear a pathogen.
• It was observed that, in many terminally ill COVID-19 patients, the body mounts an unrestrained inflammatory response
• In few patients this eventually leads to fluid accumulation in the lungs’ air sacs and the patient struggles to breathe. This condition is called acute respiratory distress syndrome (ARDS), and is often fatal.
• Dexamethasone acts by reducing the body’s heightened inflammatory response.
• In COVID-19 patients, such a pronounced inflammatory response occurs only in the terminal stages of the infection. Hence Dexamethasone was found to be effective in patients who are critically ill and depend on ventilator support.

About the Trial

– Results Based on which Dexamethasone is claimed to be effective in COVID-19 Treatment are preliminary

– The complete data regarding the case histories and other variable of the patients involved in the trial and yet to be published.

– The preliminary reports also indicate that Dexamethasone didn’t have any benefits in patients with milder symptoms.

Potential Problems

• Currently, Dexamethasone is inexpensive costing Rs 3 for a strip of 10 tablets. Also there is sufficient availability so far.
• But it is to be seen whether the price of the drug will remain low when demand increases and also whether production and supply can be increased with respect to the demand.

Side Effects

• Dexamethasone is also an immunosuppressive drug. Studies have found that patients with severe COVID-19 have a low number of cells called T-lymphocytes in their blood. Using dexamethasone could further deplete the T-lymphocyte population and worsen immunosuppression.
• High doses of Dexamethasone can also have side effects like dizziness, irregular heartbeats and increased blood sugar levels.