What is dexamethasone and how could it save coronavirus sufferers?
The steroid dexamethasone reduced COVID-19 deaths in ventilated patients by a third. (Getty Images)
A potentially life-saving coronavirus drug is being used in hospitals across the UK, according to very encouraging trial results.
Oxford University scientists announced on June 16 that the low-cost steroid dexamethasone reduced the risk of death in respiratory patients from respiratory disease COVID-19 by a third.
Early research suggests that in four out of five cases, the coronavirus is mild but can trigger COVID-19.
Had Dexamethasone been used in the UK when the outbreak began, the Oxford team could have saved up to 5,000 lives.
What is the evidence for dexamethasone?
Oxford scientists launched the RECOVERY study in March to test potential COVID-19 treatments on more than 11,500 patients in 175 NHS hospitals.
More than 2,100 patients received dexamethasone for 10 days, comparing the results to over 4,300 people who received the usual care.
COVID-19 had no "fixed" treatment. Supportive measures such as ventilation were offered while a patient's immune system was working to naturally fight off the infection.
Dexamethasone was found to reduce deaths in ventilated patients by one third 28 days after administration.
Deaths among oxygen recipients decreased by a fifth.
Dexamethasone did not benefit patients who did not receive breathing support.
Based on these results, the drug would statistically prevent the death of eight ventilated patients on dexamethasone, which can be administered orally or intravenously.
One death would also be warded off in 25 patients treated under oxygen.
"Although this appears to be a relatively modest effect on the outcome, the ventilated patient's NNT (number required for treatment) of eight is better than almost any other intervention that has been studied for ventilator patients for disease," said Professor Duncan Young from the University of Oxford.
Half of all COVID-19 patients who receive a ventilator do not survive.
Sir Patrick Vallance, the government's chief scientific advisor, called the results "tremendous news" and "groundbreaking in our fight against the disease".
How does dexamethasone work?
Dexamethasone is a steroid that reduces inflammation by mimicking anti-inflammatory hormones.
The corona virus itself can cause inflammation.
A patient's immune system can also go into high gear and lead to a "cytokine storm" that occurs when excessive amounts of the cytokines of the immune-fighting proteins are released.
Some inflammation is good because it helps fight off an infection. However, a cytokine storm can lead to dangerous internal swelling.
Dexamethasone is believed to calm this effect, but only in severe cases. Dampening the immune response in milder patients is not considered beneficial.
"The survival benefit is clear and great for patients who are sick enough to need oxygen treatment, so dexamethasone should now become the standard of care for these patients," said Professor Peter Horby, chief physician of the RECOVERY study.
How is dexamethasone available?
Dexamethasone is already used to treat inflammatory diseases such as asthma or severe allergic reactions.
It is also prescribed for disorders caused by an overreaction of the immune system, such as: B. rheumatoid arthritis.
The UK government would have expected the RECOVERY study to be a success. The UK government has reportedly stored enough of the drug to treat 200,000 people.
Health Minister Matt Hancock told the Commons that 240,000 doses of the drug are "in stock and on order".
In the UK, dexamethasone costs £ 5.40 (USD 6.76) per patient per day, with the treatment regimen lasting up to 10 days.
The drug, first produced in 1957, is not patented. This enables many different pharmaceutical companies to manufacture and distribute it around the world.
"Dexamethasone is inexpensive on the shelf and can be used immediately to save lives worldwide," said Prof. Horby.
The Department of Health and Social Affairs has stated that dexamethasone is on the government's parallel export list, which prohibits companies from buying medicines for British patients and reselling them elsewhere at a higher price.
Does it have any side effects?
In the RECOVERY study, dexamethasone patients received 6 mg once daily.
Professor Chris Whitty, England's chief physician, said "no excessive harm has been found using this dose in this patient population".
Even so, dexamethasone has been linked to anxiety, insomnia, weight gain, and fluid retention.
In rare cases, eye diseases, visual disturbances and bleeding can occur.
A woman is wearing a mask in Madrid. (Getty Images)
Are we excited too soon?
The announcement of the RECOVERY study was only a preliminary result. The study has yet to be published in a peer-reviewed journal.
While it sounds like the study was hurried to meet the demand for a COVID-19 drug, many scientists have praised the speed with which it was carried out.
"Seeing these results in such a short space of time is an incredible scientific achievement," said Dr. Nick Cammack from the Wellcome Trust.
“The data will give researchers around the world a better understanding of why the drug is effective in these patients.
“This is extremely promising news and a significant step forward, but we still have a long way to go.
"To end this pandemic, we need even better diagnoses, medications to treat, and vaccines to prevent COVID-19."
Dr. Stephen Griffin of the University of Leeds described the study as "of enormous importance".
Nevertheless, he would like further studies to examine the potential of the treatment "possibly through the combination of low-dose dexamethasone with other inflammatory mediators or with virus-related therapies such as Remdesivir".
Remdesivir, a malaria drug, appears to speed up the recovery time of COVID-19. It is given as an infusion rather than a tablet.
As a new drug, remdesivir supply is expected to be limited and the price to be high.
Dr. Dexfer Ali of Warwick Business School about Dexamethason added: “Remember, it is not a cure for everyone, just another tool. However, this shows the potential for reuse of medicines. "
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