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Fact Checked

COVID-19 Treatment Update: The Demand for Dexamethasone

The demand for a medication called dexamethasone has skyrocketed. 

It is the latest front runner in the race for a COVID-19 treatment. Dexamethasone offers a low-cost, well-studied option, and preliminary results for its use in treating critically ill patients with COVID-19 have offered hope.

Keep reading to learn about the preliminary results of the RECOVERY trial and important facts related to dexamethasone.

What is Dexamethasone? 

Dexamethasone belongs to a class of drugs called steroids (a.k.a, glucocorticoids).  The human body naturally produces steroids as part of the inflammation and disease-fighting (immunological) process. Steroids are used to treat a variety of medical conditions, such as allergic disorders, skin conditions, arthritis and breathing disorders.

How Does Dexamethasone Treat COVID-19?

In critically ill patients with COVID-19, the immune system could be compared to a runaway train. In a phenomenon called “cytokine storm,” the immune response, instead of fighting the infection, does a traitorous trick and starts to attack a patient’s healthy cells. This can lead to severe complications, including death.

Dexamethasone works by pulling the brake on the runaway train, not completely stopping it, rather slowing it down, dampening its effect.

The RECOVERY Trial and COVID-19

In March 2020, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial was established to test potential treatments for COVID-19, including low-dose dexamethasone. Preliminary results were highly favorable, resulting in increased demand for dexamethasone. 

The results, as reported by the World Health Organization (WHO), showed that dexamethasone treatment helped reduce death by one-third in mechanically ventilated patients and about one fifth in those requiring oxygen.

Who Would Benefit from Dexamethasone?

The RECOVERY trial showed a benefit among individuals who were critically ill and required respiratory support (e.g., mechanical ventilation or supplemental oxygen). 

There was no benefit observed in patients who did not require respiratory support and results suggest risk of harm could be possible with dexamethasone treatment in patients with mild symptoms. Therefore, it should not be used to treat cases of COVID-19 being managed at home or anyone in the early stages of COVID-19 infection. 

What are the Most Common Side Effects of Dexamethasone?

Dexamethasone is generally considered safe, and when used on a short-term basis (even at high doses), it typically has minimal side effects (e.g., increased blood sugars, increased appetite). 

Long-term use of dexamethasone (or any steroid) can cause multiple adverse effects (e.g., mood swings, weight gain, increased risk of infections, osteoporosis). 

What About Steroids Besides Dexamethasone?

At this time, it is not known whether other steroids such as prednisone, methylprednisolone, or hydrocortisone will have a similar role in treatment plans for critically ill patients with COVID-19 infection.

Is Dexamethasone Widely Available? 

Dexamethasone is widely available and comes with a much cheaper price tag than some of the other alternatives tested to date. The injectable form has been in short supply as of February of last year. According to this article, U.S. production of dexamethasone will amp up to meet demand. 

Additional Facts to Consider About Dexamethasone Therapy

• The results of the RECOVERY trial are preliminary and have not been published in a peer-reviewed journal 

• Very few pregnant or pediatric patients were included in the RECOVERY trial. Therefore, information about use in these special populations is relatively sparse.

• Dexamethasone is a moderate cytochrome P450 (CYP) 3A4 inducer, which means there could be potential drug interactions. A pharmacist or another healthcare provider should evaluate any potential drug interactions before starting dexamethasone therapy. 

• Remdesivir was not part of the treatment in the RECOVERY trial; therefore, the safety and efficacy of administering remdesivir and dexamethasone at the same time are not known.

• Dexamethasone SHOULD NOT be used on an outpatient basis to treat mild cases of COVID-19.

References:

Horby P, Shen Lim W, Emberson J, et al. Effect of dexamethasone in hospitalized patients with COVID-19: preliminary report. medRxiv. 2020;[Preprint]. doi: https://doi.org/10.1101/2020.06.22.20137273

Randomised Evaluation of COVID-19 Therapy (RECOVERY). Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19. 2020. Available at: https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf. Accessed June 27, 2020.

Dance, A. What is a Cytokine Storm? Discover Magazine website. Published April 14, 2020. Accessed June 27, 2020. https://www.discovermagazine.com/health/what-is-a-cytokine-storm

Roberts, M. Coronavirus: Dexamethasone proves first life-saving drug. BBC News website. June 16, 2020. Accessed June 26, 2020. https://www.bbc.com/news/health-53061281

Rabin RC, Breakthrough Drug for Covid-19 May Be Risky for Mild Cases. New York Times website. Available at https://www.nytimes.com/2020/06/24/health/coronavirus-dexamethasone.html Published June 24, 2020. Accessed June 26, 2020. 

World Health Organization (WHO). Q&A: Dexamethasone and COVID-19. WHO website. Published June 25, 2020. Accessed June 26, 2020, https://www.who.int/news-room/q-a-detail/q-a-dexamethasone-and-covid-19

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Accessed June 26, 2020. https://www.covid19treatmentguidelines.nih.gov/

Erman M, U.S. Demand Outstripping Supply of Steroid Treatment for COVID. U.S. News website. Published June 25, 2020. Accessed June 26, 2020. Available at https://www.usnews.com/news/top-news/articles/2020-06-25/us-demand-outstripping-supply-of-steroid-treatment-for-covid

Published June 26th, 2020 by Dr. Betsy Hoida, PharmD, BCPS
Fact Checked by Chris Riley

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