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HomeBlogSteroids: raising the bar in COVID-19 treatment

Steroids: raising the bar in COVID-19 treatment

By: Medix Team
Steroids: raising the bar in COVID-19 treatment

Hope for patients with severe symptoms as recent trials suggest that certain corticosteroids stop the immune system from overreacting and creating the cytokine inflammatory storm that causes organ damage. But caution may also be warranted.

When the University of Oxford rushed out its preliminary findings on the benefits of a corticosteroid called dexamethasone as a potential treatment for COVID-19 in mid-June, there was elation in many sections of the medical establishment.


Finally, here might be a breakthrough that reduces mortality rates. The drug is also out of patent, which makes it cheap and widely available.


But the announcement prompted some caution mixed with a sense of irony and déjà vu too. For nearly 60 years ago, dexamethasone’s original manufacturer, Merck, ended up in front of the United States Congress for marketing the supposed anti-inflammatory benefits of the drug months before it received permission to start selling it from the Food & Drug Administration (FDA).


The results of those congressional hearings was a 1962 amendment to the Federal Food, Drug and Cosmetic Act, which beefed up the FDA’s powers. Ever since then, pharmaceutical manufacturers have had to provide proof of a drug’s effectiveness as well as its safety before they receive approval.


The era of clinical trials was born. But the problem with clinical trials is that they take a very long time and time is one thing the world does not feel it has when it comes to finding a vaccine or suite of treatments to deal with the COVID-19 pandemic.


There has consequently been a spate of rushed announcements and subsequent controversies about the efficacy of potential vaccines or drugs so far this year. They include a swirl of conflicting opinions about the benefits of anti-malaria drug hydroxychloroquine as a potential COVID-19 treatment.


Such announcements are being dubbed science by press release and not peer review. It all demonstrates the very fine line that scientists need to tread when it comes to releasing information that may be refuted shortly after.


However, the leaders of the University of Oxford’s RECOVERY clinical trial did publish the dexamethasone results one week after their initial announcement. This showed there had been a one-third reduction in the number of deaths for patients being ventilated and one-fifth for those on oxygen.


The findings have been enough to prompt the World Health Organisation (WHO) to conclude that dexamethasone gives “us much needed reason to celebrate”.


A number of governments have added dexamethasone to their approved treatment lists. Some countries had already been using it before this and witnessed promising results. One US hospital group says it has been using dexamethasone since April to great effect.


Dexamethasone may not be the only corticosteroid that helps to prevent the inflammatory damage caused by COVID-19 either. The Henry Ford Hospital in Detroit, Michigan says that it is seeing enhanced outcomes from patients administered with one called methylprednisolone.


The reason that corticosteroids may work is because they mimic the anti-inflammatory hormones, which the body should produce naturally. The key one in this instance is cortisol, which is released by the adrenal glands, situated on top of the kidneys.


Glucocorticords liked dexamethasone and methylprednisolone are a sub-group of corticosteroids that stop the immune system from going into overdrive and overproducing cytokines, which turn the body’s healing mechanism against itself. The drug is widely used to treat inflammatory conditions such as rheumatoid arthritis, allergic reactions, skin diseases such as psoriasis and ulcerative colitis.


The Oxford University researchers suggest that dexamethasone only needs to be administered in small doses to have maximum effect. This should limit potential side effects including raised blood pressure and blood glucose.


But there is a catch and some countries are adopting a wait-and-see approach. If dexamethasone is prescribed too early, there is a danger that it suppresses the immune system while it is still trying to fight the virus off.


The Oxford University researchers agree that timing is key. They believe that day seven or eight is optimal since the viral load has started to decrease by then. For severely ill patients, this is the point when it becomes less about virus replication and more about stopping the immune system from spiralling out of control.


Consequently, dexamethasone does not prevent the virus, but it could be a potential saviour against its inflammatory after-effects. It could end up being used as one of a suite of drugs to treat COVID-19.


These may well include the Ebola drug, remdesivir too. It is being trialled for its ability to prevent viral replication during the first stage of the virus.

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