- A steroid commonly used to treat inflammation reduced deaths by about a third in COVID-19 patients on ventilators and by a fifth in those who needed oxygen support, according to researchers.
- The drug didn’t have a beneficial effect on patients without severe respiratory issues, according to the study, which evaluated more than 6,000 people with COVID-19.
- Dexamethasone is widely available and inexpensive.
Researchers in the United Kingdom say they’ve found a drug that can drastically reduce death in patients who are severely sick with COVID-19.
In a statement published Tuesday, the researchers shared that dexamethasone — a steroid commonly used to treat inflammation — reduced deaths by about a third in COVID-19 patients on ventilators and by a fifth in patients who needed oxygen support.
The drug didn’t have a beneficial effect on patients without severe respiratory issues, according to the study, which evaluated more than 6,000 people with COVID-19.
Dexamethasone, which is widely available and inexpensive, is the first drug shown to help people with severe COVID-19 survive, and should become the standard of care for very sick patients, according to the researchers.
But some health experts are skeptical about the findings and want access to the full analysis, not just a statement, proving its effectiveness.
Normally, research like this would be published in a peer-reviewed journal.
“We have to be careful because there’ve been a lot of retractions with studies because of inadequate data or an issue with the data. That said, I still am encouraged by the response that they had,” Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City, told Healthline.
What is dexamethasone?
Dexamethasone is a steroid that works on the immune system and helps reduce inflammation, redness, and pain.
It treats asthma, allergic reactions, some types of arthritis, and certain cancers.
Dr. Onyema Ogbuagu, a Yale Medicine infectious disease doctor, says the use of steroids has often been controversial.
Dexamethasone has been used to treat acute respiratory distress syndrome (ARDS) — a severe complication of respiratory infections like COVID-19 and influenza — but the outcomes have been mixed for other diseases similar to COVID-19.
Steroids were also evaluated as a treatment for SARS and MERS — again, the results were varied.
Some studies claimed steroids elongated patients’ hospital stays, made it harder for the body to get rid of the virus, and increased people’s risk for death.
“In prior coronavirus outbreaks [SARS and MERS], use of steroids actually had been associated with worse outcomes and mortality, which is concerning, or even just a decreased ability to clear the virus,” Ogbuagu said.
It could help a small subset of patients
When the medical community is faced with a new disease with a high risk of death, doctors try to use treatments based on clinical experience, their understanding of a disease, and their best judgment, says Ogbuagu.
Ogbuagu says it’s difficult to give a uniform recommendation about using steroids.
Doctors in the United States have already been trying the drug on certain patients with COVID-19.
In general, doctors don’t think steroids are a good idea for all COVID-19 patients, no matter their condition. But as this study shows, a small subset of patients with severe disease may find benefit, according to Ogbuagu.
In severe cases of COVID-19 — specifically, patients who are on oxygen or intubated — the body can produce a cytokine storm. This is an exaggerated immune response to the virus that causes widespread inflammation.
Ogbuagu says this extreme immune response can help clear the virus, but it can also cause a lot of damage, including worsening of lung inflammation, or ARDS.
“Anti-inflammatories are being mostly explored in the context of severe disease or in people in the later part of the COVID-19 illness, hoping to tempt down that exuberant immune response and hopefully decrease lung injury that occurs and some of the other complications that follow COVID,” Ogbuagu said.
Steroids have a robust effect and diminish the entire immune system, which is why some people involved in past studies on MERS, for example, had trouble clearing the virus.
It’s worth noting that steroids can have other adverse effects.
They can raise blood pressure and blood sugar levels, and increase the risk of secondary bacterial infections.
Doctors need to be selective about which patients get steroids.
“Steroids are not for everyone, but they could be beneficial for some people,” Ogbuagu said.
We need more research
Health experts agree that we need more data on dexamethasone to be published and peer-reviewed before it becomes the go-to treatment for patients with severe illness.
“For those patients who do require oxygen or are intubated, [dexamethasone] certainly deserves a more careful look — but that only comes with publishing this study and peer review,” Glatter said.
Dexamethasone needs to be studied at a molecular level, or how it physiologically affects the body, Glatter notes, so doctors can better understand how to best use it.
Ogbuagu would like to see corroborating studies supporting the use of dexamethasone too.
Finally, Glatter emphasizes that dexamethasone wasn’t used to protect or prevent people from getting COVID-19. It hasn’t been studied in any way as a preventive method, so people shouldn’t use it as such.
“We have to be careful, we have to be methodical, we have to be very particular in adopting new therapies with [severe COVID-19] patients,” Glatter said. “We just can’t adopt a new drug until we fully study it.”
The bottom line
Researchers in the United Kingdom say that dexamethasone, a steroid commonly used to treat inflammation, can drastically reduce death in patients who are severely sick with COVID-19.
In a study of more than 6,000 COVID-19 patients, it reduced deaths by a third in patients on ventilators and by a fifth in patients needing oxygen support.
However, the research hasn’t yet been published in a peer-reviewed journal.
The drug had no benefit on people with milder illness. The use of steroids has historically been controversial, and while not all COVID-19 patients will benefit from the drug, those who are severely sick and experiencing extreme inflammation may benefit.