Dexamethasone: Scientific community reacts to potential COVID-19 treatment

It’s low-cost and widely available and yet dexamethasone is the drug that has researchers' tongues wagging after a UK trial showed it reduced deaths among COVID-19 patients.

In trial results that scientists called a “major breakthrough”, a low dose of the drug reduced death rates among ventilated COVID-19 patients by around a third.

The steroid was still beneficial for hospitalised patients receiving only oxygen – reducing deaths by one fifth – but had no benefit among COVID-19 patients who did not need respiratory support.

The results mean that one death would be prevented by the treatment of around eight ventilated patients or 25 requiring oxygen alone.

Oxford University’s Professor Peter Horby, one of the trial’s chief investigators, said the survival benefit was “clear and large” in patients sick enough to require oxygen treatment, so added dexamethasone should now become standard of care in these patients.

“Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide,” he said.

While the finding is making headlines worldwide, the research paper is yet to be peer-reviewed or published. The Oxford team said it was working make that happen as soon as possible.

And before Australia dolls it out, Associate Professor Nial Wheate, program director of undergraduate pharmacy at the University of Sydney, said we need to wait for the full study data and scientific peer-review and balance its risks and benefits.

Writing for The Conversation, Wheate said there are potential complications with using the drug.

“Dexamethasone also suppresses the immune system when it reduces inflammation. So, it’s not usually recommended for people who are sick, or could be sick, from other infections. So doctors will need to make sure patients have no other infections before they are prescribed the drug,” he wrote.

“If the results of this trial are correct though, the drug doesn’t appear to compromise the patient’s ability to fight COVID-19; it might just affect their ability to fight off other diseases.”

He added that its side effects would need to be monitored

“Serious, but rare ones include: severe stomach or intestinal pain, sudden changes with vision, fits, significant psychiatric or personality changes, severe dizziness, fainting, weakness and chest pain or irregular heartbeat, and swelling of the face, lips, mouth, tongue or throat, which may cause difficulty in swallowing or breathing.”

And given retractions of findings surrounding drugs researchers previously hoped would help COVID-19 patients, like an analysis on hydroxychloroquine published in The Lancet, experts are urging caution.

Professor Atul Gawande, from the Harvard T.H. Chan School of Public Health, tweeted: “It will be great news if dexamethasone, a cheap steroid, really does cut deaths by 1/3 in ventilated patients with COVID-19, but after all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper.”

Writing for The Guardian, Professor Devi Sridhar, chair of global public health at the University of Edinburgh, said we should not think of dexamethasone as a magic bullet.

Sridhar said: “This drug looks only effective in those patients already in a critical state. The real game-changer will be a drug that prevents people transitioning from mild symptoms to a severe state. With such a drug, alongside widespread testing and early detection, patients could be treated in community and outpatient clinics.”

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