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What is dexamethasone? The life-saving drug which is being termed as a 'breakthrough' in treating COVID-19

Dexamethasone is a low-cost steroid that has been used since the 1960s to reduce inflammation in a range of conditions, including inflammatory disorders and certain cancers.
Jun 17, 2020 / 12:26 PM IST

A ray of hope has emerged amid the coronavirus pandemic, as researchers in England say they have the first evidence that low doses of the steroid dexamethasone can improve COVID-19 survival.

The analysis is part of the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial which was established to test a range of potential therapies for COVID-19, including low-dose dexamethasone -- a steroid treatment.

The study is a large, strict test that randomly assigned 2,104 patients to get the drug and compared them with 4,321 patients getting only usual care.

The drug was given either orally or through an IV. It reduced deaths by 35 percent in patients who needed treatment with breathing machines and by 20 percent in those only needing supplemental oxygen. However, it did not appear to help less ill patients.

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How does a vaccine work?

A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

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There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

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Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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What is dexamethasone?

Dexamethasone is a low-cost steroid that has been used since the 1960s to reduce inflammation in a range of conditions, including inflammatory disorders and certain cancers.

It is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders.

It has been listed on the World Health Organization (WHO) Model List of Essential Medicines since 1977 in multiple formulations and is currently off-patent and affordably available in most countries.

What was the trial?

The use of dexamethasone, a corticosteroid, was analysed as a part of the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial. The RECOVERY trial included over 11,500 patients, enrolled from more than 175 hospitals in the UK, noted a statement published by the University of Oxford.

The trial, a total of 2,104 patients were randomised to receive dexamethasone six milligrams once per day -- either by mouth or by intravenous injection -- for ten days, and were compared with 4,321 patients randomised to usual care alone.

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What are the results of the trial?

In the study, scientists found that dexamethasone reduced deaths by one-third in ventilated patients, and by one fifth in other patients receiving oxygen only.

However, the researchers said there was no benefit from dexamethasone among the patients who did not require respiratory support.

Based on these results, the scientists believe that the drug could prevent nearly one death in the treatment of around eight ventilated patients, or around 25 patients requiring oxygen alone.

What have researchers involved in the trial said on the results?

According to Peter Horby, one of the chief investigators of the trial from the University of Oxford in the UK, Dexamethasone is the “first drug to be shown to improve survival in COVID-19.”

The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients, added Horby.

Martin Landray, another chief investigator of the trial from the University of Oxford said the preliminary results from the RECOVERY trial are very clear that dexamethasone reduces the risk of death among patients with severe respiratory complications.

COVID-19 is a global disease and it is fantastic that the first treatment demonstrated to reduce mortality is one that is instantly available and affordable worldwide, Landray added.

The drug, according to the scientists, is inexpensive, on the shelf, and can be used immediately to save lives worldwide.

What WHO and other experts say?

The WHO has welcome the initial clinical trial results from the United Kingdom (UK) that show dexamethasone can be lifesaving for patients who are critically ill with COVID-19.

“This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Faheem Younus, Chief of Infectious Diseases, University of Maryland Upper Chesapeake Health, tweeted about the good and bad side of the drug. In the tweet, he said the good thing about the drug is clinical/mortality benefit, and it's cheap, tried and tested.

For the bad part, he mentioned that the drug has significant short/longterm side effects, as it suppresses immunity, causes bleeding and weight gain.

Is the usage of dexamethasone allowed?

The drug is banned in-competition by the World Anti-Doping Agency (WADA) but its usage is allowed out-of-competition if athletes have the requisite Therapeutic Usage Exemption (TUE).

Follow our full coverage on COVID-19 here.
Somya Lohia
first published: Jun 17, 2020 12:26 pm
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