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Dexamethasone May Reduce Mortality Rate in COVID-19
Dexamethasone is a generic steroid drug widely used in cases of inflammatory disorders like rheumatism, asthma and allergies.
The UK-based recovery trial conducted by Oxford University states a low-dose regimen of dexamethasone for 10 days reduces the death rate by one-third. BBC quoted chief investigator Prof. Peter Horby saying- ‘This is the only drug so far that has been shown to reduce mortality- and it reduces it significantly. It's a major breakthrough’. Few researches also suggest that it minimises the death rate from 40% to 28% for the patients on ventilators and from 25% to 20% for those who require oxygen. The Associate Press reports that the drug will prevent one death for every eight patients treated while on ventilator, and one for every 25 patients on extra oxygen alone.
Dexamethasone, a synthetic glucocorticoid, mimics the action of cortisol. It acts as both anti-inflammatory and immunosuppressive. On the biochemical level, glucocorticoids bind with the receptor in the cell cytoplasm. This triggers a cascade of reactions and suppresses proinflammatory cytokines interleukin-1 (IL-1), IL-2, IL-6, IL-8, tumour necrosis factor-alpha and interferon-gamma. Five of these are linked to the severity of coronavirus disease 2019 (COVID-19). Moreover, glucocorticoids also inhibit the overactivation of macrophages, which is the major cause of COVID-19 cytokine storm.
Immunosuppressive effects and potential side effects are the cause of major concern for corticosteroids. However, a review conducted in 2013 states that ‘the chronic use is associated with a sobering list of adverse effects, but a few days of steroid therapy [including dexamethasone] is generally free of significant side effects’.
Researches also demonstrate that remdesivir has no significant effect on death rate, rather it only shortens the hospital stay. Hydroxychloroquine reduces mortality, but it produces no significant changes in patients who need intensive care unit level of care. Moreover, it is also known to produce cardiac complications.
Dexamethasone is turning out to be the solution for patients suffering from COVID-19, but it is helpful only in critical cases, and not in those with mild ailments. Hence, stockpiling of this drug is not required.
04 September 2020 (online)
Thieme Medical and Scientific Publishers Private Ltd.