What is Dexamethasone, Its Benefits to COVID-19 Patients? Dr. Badran Answers

More than 8 million people worldwide have tested positive for COVID-19 and over 453,485 people have died of coronavirus, including over 120,239 in the United States, according to data compiled by Johns Hopkins University.

There are currently no approved treatment therapies or cure to fight COVID-19. More than 110 groups are working on developing a vaccine for the pandemic, which haven't been approved for public use either.

Dexamethasone is an anti-inflammatory drug normally used to treat a range of allergic reactions as well as rheumatoid arthritis and asthma. Dexamethasone is the first and only drug that has made a significant difference to patient mortality for COVID-19. Cheap, widely available steroid reduces death risk in severe coronavirus cases.

What is Dexamethasone drug that help COVID-19 patients?

Dexamethasone is a type of corticosteroid medication. Dexamethasone was first made in 1957 by Philip Showalter Hench and was approved for medical use in 1961 . It is on the World Health Organization's List of Essential Medicines. In 2017, it was the 321st most commonly prescribed medication in the United States, with more than one million prescriptions.

Prednisone and methylprednisolone, which are intermediate-acting products, are four to five times more potent than hydrocortisone. Dexamethasone is a long-acting, systemic corticosteroid; its potency is about 25 times greater than the short-acting products.

Mechanism of Action

Dexamethasone is often given in low doses as an anti-inflammatory. It is used widely for severe asthma, allergies and when joints are painful and swollen. It is also used in autoimmune conditions such as systemic lupus erythematosus among other conditions, including certain types of cancer.

Cortisol is a catabolical hormone that causes lipolysis and fat redistribution, as well as breakdown of body tissues such as muscle, skin, and bone. The anti-inflammatory and immunosuppressive effects of dexamethasone are approximately 30 times more potent than cortisol. Anti-inflammatory effects are complex, but primarily via inhibition of inflammatory cells and suppression of expression of inflammatory mediators.

Dexamethasone is Creating Cautious Optimism

The World Health Organization welcomes the initial clinical trial results from the United Kingdom that show dexamethasone, can be lifesaving for patients who are critically ill with COVID-19.

It's effect on inflammation and our immune systems that makes it useful in fighting off the worst effects of COVID-19.The majority of people with COVID-19 show no signs of the disease – they are asymptomatic – or they have mild symptoms such as a dry cough, slight fever or loss of taste and smell. But in a small minority, the symptoms are much worse and patients need oxygen therapy or ventilation to help the lungs get oxygen into the body. These are the people for whom dexamethasone was shown to be effective.

In severe cases, the body's immune system over-reacts to the virus and mounts an attack on the cells that contain it. This is known as a cytokine storm, where chemicals called cytokines are released by cells of the immune system, causing excessive inflammation.

Dexamethasone acts on the immune system to dampen the response and reduce the cytokine storm. In effect, it prevents the massive inflammation seen in the lungs and the heart which are responsible for severe respiratory problems in very ill patients.

Dexamethasone has been tested in the largest COVID-19 drug trial to date, the Randomised Evaluation of COVID-19 Therapy or RECOVERY trial for short. As part of the trial, researchers studied the effect of the drug in 2,000 patients and compared that to the outcomes in 4,000 patients who did not receive it.

The results of the trial, which have not yet been published in a peer-reviewed journal, show the biggest benefit was in those patients on ventilators, where dexamethasone reduced the risk of death by 12 percent from 40 to 28 percent. For those requiring oxygen, there was a 5 percent reduction from 25 to 20 percent. This equates to one life saved for every eight on ventilators and every 20-25 treated with oxygen.

The drug is ineffective in those with mild symptoms who do not require respiratory support and should not be used by those at home. Half of all Covid patients who require a ventilator do not survive, so cutting that risk by a third would have a huge impact. The drug is given intravenously in intensive care and in tablet form for less seriously ill patients.

What Are Side Effects of Dexamethasone?

Side effects of dexamethasone include: vision changes, swelling, rapid weight gain, sleep problems (insomnia), mood changes, acne, dry skin, thinning skin, bruising or discoloration, slow wound healing, increased sweating, headache, dizziness, spinning sensation, nausea, stomach pain, bloating, muscle weakness, or changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

Recorded side effects of dexamethasone include also vertigo, increased appetite, depression, euphoria, hypertension, increased risk of infection, raised intraocular pressure, vomiting, confusion, amnesia, irritability, nausea, malaise, and cataract (in cases of long-term treatment it occurs in about 10% of patients).

Rare instances of severe allergic reactions (anaphylaxis) have occurred in patients receiving corticosteroid therapy such as dexamethasone.

Other side effects of dexamethasone include growth stunting (in children) , peptic ulcer, osteoporosis, myopathy, diabetes mellitus type 2 , pancreatitis (inflammation of the pancreas), sodium and water retention, mania , psychosis, glaucoma, cardiomyopathy, abdominal distension, corneal or scleral thinning , telangiectasia , vertebral collapse , esophageal ulcer , seizures , intracranial hypertension (long-term treatment) , hypocalcaemia , muscular atrophy , nitrogen depletion due to protein catabolism and candidiasis .

Sudden withdrawal after long-term treatment with corticosteroids can lead to: hypotension, fever, myalgia, arthralgia, rhinitis, conjunctivitis , painful itchy skin nodules and weight loss .

Dexamethasone During Pregnancy and Breastfeeding

Dexamethasone crosses the human placenta. Infants born to mothers who have received substantial doses of corticosteroids during pregnancy should be carefully observed for signs of hypoadrenalism.

Dexamethasone has been detected in human breast milk. Because of the potential for serious adverse reactions in nursing infants from corticosteroids, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Use in pediatric patients is recommended to be done in consultation with a pediatric specialist.