To date, the COVID-19 pandemic has resulted in over 6 million deaths globally. Swift and efficient treatment remains critical in order to minimize deaths and other negative outcomes.1 Recent research has examined dexamethasone, an anti-inflammatory drug, as a potential treatment option for COVID-19.
A number of efficacious COVID-19 treatments have been developed so far. These include antivirals, such as ritonavir-boosted nirmatrelvir (Paxlovid) and remdesivir (Veklury) for eligible patients,2 as well as intravenously infused monoclonal antibodies, such as Bebtelovimab, which was granted emergency use authorization (EUA) by the Food and Drug Administration (FDA) earlier this year.3
Most recently, dexamethasone, a corticosteroid which acts to suppress the inflammatory reactions linked to an overstimulated immune system, has emerged as a viable treatment option in cases of severe or critical COVID-19.4 However, its use remains highly regulated and is limited to specific clinical context.5
In an attempt to compare a range of possible treatments in patients hospitalized with COVID-19, a 2021 study randomly assigned patients to receive usual care alone or oral or intravenous dexamethasone (6 mg daily) for up to 10 days. Data demonstrated that the use of dexamethasone resulted in lower 28-day mortality rates among those who had received invasive mechanical ventilation or oxygen alone, but not among those who had not received any respiratory support.
More recently, a 2022 study sought to assess whether continuing dexamethasone treatment after patient discharge is associated with reduced readmissions or mortality rates. Data from the retrospective cohort study demonstrated that continuing treatment with dexamethasone (6 mg daily) at discharge was not linked to a significant reduction in 14-day readmission or mortality.6 As such, this study suggests that dexamethasone should not be routinely prescribed beyond discharge for COVID-19 patients.
Dexamethasone is considered to be inappropriate in non-severe COVID-19 cases. A recent pilot randomized control trial highlighted a relatively unfavorable disease course in patients with non-severe COVID-19 who received dexamethasone in a non-hospital setting.8 Among other outcomes, such patients were found to have longer recovery times.
In addition, it has long been known that an excessively high dose of dexamethasone may precipitate a number of negative side effects, including gastrointestinal issues, headache, dizziness, and insomnia.5
Some data suggests that other corticosteroids may be more effective. A 2021 study focused on COVID-19 patients with pneumonia compared tmethylprednisolone and dexamethasone. The data showed that the treatment of severe COVID-19 pneumonia with three days of high-dose methylprednisolone followed by 14 days of oral prednisone, compared with 7 to 10 days of 6 mg dexamethasone, significantly decreased patient recovery time, the need for intensive care, and the levels of disease severity markers (C-reactive protein (CRP), lactate dehydrogenase, and D-dimer).7
In light of these data, Centers for Disease Control (CDC) guidelines currently recommend against the use of systemic corticosteroids in non-hospitalized COVID-19 patients without another indication.9 Overall, however, in the UK and globally, the clinical use of corticosteroids, including dexamethasone, is on the rise, particularly among patients under 70 years of age.10
As COVID-19 continues to infect people across the globe, ongoing research is needed to continue the development of treatments and to minimize negative health outcomes and mortality into the future.
References
1. WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data. Available at: https://covid19.who.int/. (Accessed: 12th April 2022)
2. Interim Clinical Considerations for COVID-19 Treatment in Outpatients | CDC. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/outpatient-treatment-overview.html. (Accessed: 17th August 2022)
3. Treatments for COVID-19 – Harvard Health. Available at: https://www.health.harvard.edu/diseases-and-conditions/treatments-for-covid-19. (Accessed: 12th April 2022)
4. Coronavirus disease (COVID-19): Dexamethasone. Available at: https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-covid-19-dexamethasone. (Accessed: 17th August 2022)
5. Dexamethasone: MedlinePlus Drug Information. Available at: https://medlineplus.gov/druginfo/meds/a682792.html. (Accessed: 17th August 2022)
6. Huang, C. W. et al. Association Between Dexamethasone Treatment After Hospital Discharge for Patients With COVID-19 Infection and Rates of Hospital Readmission and Mortality. JAMA Netw. Open 5, e221455–e221455 (2022). doi: 10.1001/jamanetworkopen.2022.1455.
7. Pinzón, M. A. et al. Dexamethasone vs methylprednisolone high dose for Covid-19 pneumonia. PLoS One (2021). doi:10.1371/journal.pone.0252057
8. Kocks, J. et al. A potential harmful effect of dexamethasone in non-severe COVID-19: results from the COPPER-pilot study. ERJ Open Res. 8, 00129-2022 (2022). doi: 10.1183/23120541.00129-2022
9. COVID-19 Treatment Guidelines. Available at: https://www.covid19treatmentguidelines.nih.gov/. (Accessed: 17th August 2022)
10. Närhi, F. et al. Implementation of corticosteroids in treatment of COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK: prospective, cohort study. Lancet Digit. Heal. (2022). doi:10.1016/S2589-7500(22)00018-8