Dexamethasone shows promise in treatment of severely ill COVID-19 patients: All you need to know about the steroid drug

The Oxford University announced that dexamethasone, a common steroid drug, has shown promise in the treatment of severely ill COVID-19 patients by improving their survival rate by at least 20 percent.

Shortly after the announcement, the government of the UK reportedly announced that the drug would be authorised for the treatment of COVID-19 patients who are on ventilators or receiving oxygen therapy. Dexamethasone had been a part of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trials that began in March in the UK. The trial aims to find potential treatments for COVID-19. Congratulating the UK government, researchers and all others involved, WHO’s director-general  Dr Tedros Adhanom Ghebreyesus said in a press release on Tuesday that this is great news as it is “the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support”. What is dexamethasone originally used for? According to the WHO, dexamethasone is a corticosteroid drug that has been used since the 1960s to treat inflammatory conditions like asthma, atopic dermatitis and conditions of the gut, liver, kidneys and endocrine system and certain cancers. The drug is currently off-patent and is hence more affordable since it can be made by anyone. How does dexamethasone work? Dexamethasone is a glucocorticoid agonist that binds with the glucocorticoid receptors present inside body cells. Glucocorticoids are a type of steroids that our body makes to fight inflammation. An agonist of glucocorticoids will improve the function of these steroids. The dexamethasone-glucocorticoid receptor complex then stops the infiltration of immune system molecules at the site of inflammation. They also interfere with the function of inflammatory mediators and reduce scar formation and oedema (swelling caused by excess fluid). Studies show that dexamethasone improves circulation and surfactants in the lungs. Surfactants are protein-lipid and carbs that support breathing. The drug has a half-life (time within which half of the drug gets out of our system) of about three hours and is eliminated from the body through urine. What does the UK study say? For the study, about 2,000 people were given 6 mg of dexamethasone daily, either orally or through an IV for about 10 days. The control arm consisted of about 4,000 patients who received standard treatment. The study found that dexamethasone reduced death by 1/3rd in the patients on ventilator support and by one-fifth in those on oxygen therapy. No effect was seen in those who did not need oxygen supplementation. What are the side effects of dexamethasone? According to the US Food and Drug Administration (FDA), dexamethasone has some of the following side effects:

• Some people are allergic to the components of this drug.
• Excess use of corticosteroids can increase blood pressure.
• Those who are taking corticosteroids are more prone to infections than a healthy person.

These side-effects are why healthcare practitioners use the lowest possible dose for treatment. According to the US National Library of Medicine, dexamethasone can also cause a headache, vomiting, stomach ache, acne, anxiety, and menstrual irregularities. Is dexamethasone safe for pregnant and nursing mothers? Animal studies show that corticosteroids can cause birth defects in babies. It can also show up in breast milk. So it is only given to pregnant and lactating women when the perceived benefits are more than the potential harm. Does India manufacture dexamethasone? As per media reports, dexamethasone is largely made by Zydus Cadila and Wockhardt Ltd in India. Though it is also made by some other companies like Novartis and Cipla and is reportedly exported too. For more information, read our article on Drugs being repurposed for COVID-19. Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.