Dexamethasone, all anti-Covid-19 effects

Dexamethasone, all anti-Covid-19 effects

An inexpensive and widely available corticosteroid, dexamethasone, significantly improves the prognosis of patients most severely affected by Covid-19, writes Le Monde .

An inexpensive and widely available corticosteroid, dexamethasone, significantly improves the prognosis of patients most severely affected by Covid-19, writes Le Monde . According to preliminary results of the British Recovery clinical study, published on Tuesday June 16, this treatment would reduce the mortality of patients undergoing mechanical respiratory assistance by one third and by one fifth in those who receive only oxygen.

These proportions, relative to the mortality rates observed in patients undergoing standard therapy, mean that this treatment would prevent one death for every eight ventilator patients and one death for every twenty five oxygen patient.

If it had been prescribed for all patients hospitalized for Covid-19 since the outbreak, according to the BBC , 5,000 lives would have been saved in the UK, which has so far suffered nearly 42,000 deaths. The UK government will immediately make this treatment available to affected patients at an estimated cost of the equivalent of 60 euros.

Dexamethasone is used in a wide variety of conditions, including those of inflammatory or autoimmune origin. It was included in the recovery test in March along with five other treatments: lopinavir-ritonavir, hydroxychloroquine, azithromycin, tocilizumab and convalescent plasma. Supporters hoped that the anti-inflammatory and immunoregulatory properties of dexamethasone could be useful in the worsening stages of the disease, marked by an "immune storm" in which the body's defenses turn uncontrollably against it.


In fact, a "significant benefit" was found in the 2,104 patients in the Recovery study who were randomly assigned to this treatment, compared to more than 4,300 patients who received only standard care. The benefit was therefore more pronounced in those on fans (mortality reduced by one third) and then in those receiving oxygen (reduced by one fifth). In contrast, mortality did not change significantly in patients who did not require respiratory assistance (13% mortality in the control group).

According to Peter Horby, professor of emerging infectious diseases at the University of Oxford and one of the principal investigators of the study, "dexamethasone is the first drug that has been shown to improve survival" in the event of an infection. This is in fact the first time that a large randomized clinical trial has shown a net effect of a drug on Covid-19 related mortality.

Preliminary results for Remdesivir marketed by Gilead showed a reduction in hospitalization times, but no significant change in mortality. In France, encouraging preliminary results have been presented on the anti-inflammatory drug tocilizumab, while the corresponding clinical study of Corimuno has not yet been completed, so the conclusions are not yet known.


As for hydroxychloroquine , the recovery process has already made a decision: on June 5, its officials announced that they "concluded that hydroxychloroquine has no beneficial effect on patients hospitalized with Covid-19".

In the United States, the U.S. Food and Drug Administration (FDA) announced on June 15 that it was withdrawing authorization to treat Covid-19 because it "is unlikely to be effective" and because of "serious side effects". The promoters of the treatment recommended in France by Didier Raoult claim that it should be administered as soon as possible after diagnosis, in combination with azithromycin.

As for dexamethasone, Peter Horby points out that "the survival benefit is clear and significant in patients who are sick enough to require oxygen treatment, so it should now become the standard of care for these patients. Dexamethasone is inexpensive, over the counter, and can be used immediately to save lives around the world. "

"It's very nice to have these results," says the head of the infectious disease department of the Bichat hospital in Paris. In France, some departments were already using this Covid-19 molecule in common practice to combat the inflammatory phase of the disease. Recovery confirms that the benefit is greater for ICU-ventilated patients. »

Doctors are discussing the best dosage and timing of dexamethasone because corticosteroids are also known to promote virus multiplication. "We would like to receive a scientific article soon from Recovery to find out more," says the doctor. British researchers are engaged in this.

(Excerpt from the Epr Comunicazione press review)

This is a machine translation from Italian language of a post published on Start Magazine at the URL on Thu, 18 Jun 2020 05:10:14 +0000.