There’s quite a bit of COVID-19 news today. Let’s start here. There’s a report at CNBC that a widely-available drug has been found to be effective in treating COVID-19:
Dexamethasone, a cheap and widely used steroid, has become the first drug shown to be able to save lives among Covid-19 patients in what scientists hailed as a “major breakthroughâ€.
Results of trials announced on Tuesday showed dexamethasone, which is used to reduce inflammation in other diseases, reduced death rates by around a third among the most severely ill Covid-19 patients admitted to hospital.
The results suggest the drug should immediately become standard care in patients with severe cases of the pandemic disease, said the researchers who led the trials.
“This is a result that shows that if patients who have Covid-19 and are on ventilators or are on oxygen are given dexamethasone, it will save lives, and it will do so at a remarkably low
Dexamethasone has been around and widely prescribed for a variety of inflammatory conditions for 60 years. It isn’t a panacea but having something that could save a few more lives is a start.
It is surprising in a good way. The WHO and the Lancet had advised against using corticosteroids (including dexethasone) in Feb (https://www.contagionlive.com/news/is-there-any-reason-to-use-corticosteroids-in-coronavirus-treatment)
This is why RCT’s are necessary.
Through good doctors are needed with this drug — it has known side effects on the kidneys and bones.
From CuriousOnlooker’s link: “authors point to data across respiratory syncytial virus, SARS, MERS, and influenza which demonstrate potential harm from administration of corticosteroids in a scientifically unproven context.”
I believe that’s mentioned in the video accompanying Dave’s link by the former FDA chief, that corticosteroids had not been shown to work in analogous situations. Is that because the later progression of the corona virus is much more severe in its inflammatory response?
Not surprising. There was a study out of Spain in March which suggested that steroids were having a positive effect. We added them to our protocol in April. A lot of other hospitals did also so I would suspect it was already the standard of care at most hospitals. I told you guys about this. (Haven’t seen the original paper yet.)
” Is that because the later progression of the corona virus is much more severe in its inflammatory response?”
Yup. Ordinarily we want the immune system to respond when you have an infection, but if the inflammatory response is overblown it becomes harmful so you need to suppress it. It is surprising to me that relatively small doses work. Dont know about SARS, MERS and RSV, but with the flu it is usually secondary infection and not the exaggerated inflammatory response that kills.
” it has known side effects on the kidneys and bones.”
We use this drug a lot. Probably 80% of pts going to the OR receive it, mostly for its anti-emetic effects. Like most steroids it is longer term use which causes serious problems. Short term I would be worried about glucose control. Reports on that being an issue are just anecdotal and somewhat mixed. I know that we had some pts on very high insulin infusions but cant remember if they were receiving steroids.
Steve
IIRC there have been some reports of that as a side effect of COVID-19.
Those side effects were from studies of patients treated with high dosage of corticosteroids for the original SARs.
This is a somewhat different virus, and the dosage regimen in the trial sounds different from those tried 15 years ago. Fingers crossed!
In vet school we were taught to “never let them die without steroids.†Old school vets used to overdo it, but this class of drugs really does help a lot of conditions.
Maybe Steve can comment if this is true in humans but on the potential side effect of hyperglycemia, cats are very susceptible but it is transient and blood sugar generally goes back to normal range when the meds are finished.