Cheap Steroid Could Slash COVID-19 Death Risk
With U.S. fatalities from COVID-19 nearing 117,000, British scientists delivered some welcome news on Tuesday: A drug that appears to cut the odds of death in ventilated patients by one-third.
The drug is a low-cost steroid called dexamethasone, which has been in use for decades, noted a team at the University of Oxford.
In a trial of more than 6,000 patients, use of dexamethasone was also found to lower the death rate for slightly less-sick patients -- those receiving oxygen but not on a ventilator -- by about one-fifth.
Dexamethasone was of no benefit to patients with milder cases of COVID-19.
However, it "is the first drug to be shown to improve survival in COVID-19," study co-lead investigator Peter Horby, professor of emerging infectious diseases at the University of Oxford, said in a statement, The New York Times reported.
"The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment," he added.
According to Horby, given its cheap price tag and wide availability, there's no reason why dexamethasone shouldn't become the standard of care for severe cases of COVID-19.
"Bottom line is, good news," Dr. Anthony Fauci, who directs the U.S. National Institute of Allergy and Infectious Diseases, told the Associated Press. "This is a significant improvement in the available therapeutic options that we have."
One doctor's story
The findings have yet to be published in a peer-reviewed journal. But Dr. Robert Glatter, an emergency medicine physician at New York City's Lenox Hill Hospital, has seen the drug's effectiveness firsthand
He recently used dexamethasone to help treat a young colleague, Dr. Scott Krakower, who is unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y.
Krakower was hit hard by severe COVID-19. He was having difficulty swallowing and breathing, Glatter explained, due to intense inflammation of his upper airway.
From his emergency medicine training and many years of clinical experience, Glatter recognized the potential dangers associated with upper airway or throat swelling and opted to use dexamethasone.
"Dexamethasone has potent anti-inflammatory properties to reduce the adverse or unwanted metabolic or cellular effects related to an infection," Glatter explained. "It has the ability to increase expression of certain proteins that decrease inflammation, but also the ability to decrease production of those that trigger inflammation."
Among steroids, dexamethasone is also known "for its speed of action, greater potency compared to other steroids, as well as length and duration of clinical effects," Glatter said.
The treatment was beneficial, with immediate and longer term effects, Glatter said. Krakower was given effective further treatment by a pulmonology specialist at Northwell Health. While he still has residual symptoms, such as shortness of breath and trouble swallowing, he is gradually improving.
Used in combination?
In the British trial, about 2,100 patients with COVID-19 received low-dose dexamethasone, either orally or intravenously for 10 days, and their outcomes were compared to those of 4,300 patients who got standard care.
Fauci said that it made sense a steroid would help people with more severe COVID-19, versus those with early or milder cases. Used early for an infection, a drug like dexamethasone would actually hamper the immune system's efforts to clear the virus, he noted.
But in more severe, late-stage illness, the immune system's response has gone too far, so it "is hurting you more than helping you," Fauci told the Times. Therefore, using dexamethasone at this point makes "perfect sense," he said, because it can help quiet that response.
British Health Secretary Matt Hancock told the Times that, based on early evidence that the steroid might help patients, Britain has already stockpiled 200,000 doses.
A full course of dexamethasone costs just $20 to $30, study co-leader Dr. Martin Landry, also of Oxford, told AP.
Scientists are also looking into whether using dexamethasone in combination with other drugs, including the promising antiviral remdesivir, might provide added benefit. However, "we don't know yet" if that would prove true, Fauci cautioned.
The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.
SOURCES: Robert Glatter, MD, emergency medicine physician, Lenox Hill Hospital, New York City; The New York Times, Associated Press