Dexamethasone and COVID-19

Dexamethasone is being hailed in the media as the ‘world’s first coronavirus treatment proven to reduce the risk of death’. Here’s what we know about dexamethasone now.

Dexamethasone and COVID-19

You may have read about dexamethasone in the media. The medicine is being hailed as the ‘world’s first coronavirus treatment proven to reduce the risk of death’. Here’s what we know about dexamethasone, and what recent developments might mean for people with COVID-19.

 

What is dexamethasone?

In Australia, dexamethasone is the active ingredient in a number of prescription-only corticosteroid medicines. Corticosteroids are man-made (synthetic) versions of a hormone our bodies produce, called cortisol. Cortisol plays many important roles in our bodies, and one of them is to help reduce inflammation.

Dexamethasone is used in the treatment of many different conditions, including severe allergies, severe or chronic asthma, skin problems, arthritis, inflammatory diseases of the bowel and some types of cancer.

How does it work?

Dexamethasone and other corticosteroids work by reducing inflammation.

Inflammation can happen for a number of reasons. One of the main causes of inflammation is an immune system response to injury, or to a pathogen (a type of germ that causes disease or illness). This reaction is supposed to be helpful because the irritated area will receive an increase in blood supply, ideally rich in white blood cells, which help heal injuries and fight off infection.

Unfortunately, for reasons not properly understood, sometimes the body’s inflammatory process doesn’t work as it should. In the case of autoimmune diseases, the immune system wrongly labels parts of the body as harmful and causes an inflammatory response that isn’t needed. For people with rheumatoid arthritis, for example, the immune system targets the joints, and causes pain, swelling and stiffness in those areas. Corticosteroids are used as a treatment for diseases like these to help reduce the inappropriate inflammatory response.

Find out more about dexamethasone tablets available in Australia

 

But isn’t an immune response important to fight COVID-19?

It is, and some researchers have been apprehensive about the use of corticosteroids because they might inhibit the immune response.

Inflammatory response

However, sometimes the body’s inflammatory response to disease and infection is exaggerated and becomes counterproductive.

For example, people who become very sick from COVID-19 can develop severe viral pneumonia, which is inflammation of the lungs. The parts of the lungs that are vulnerable to inflammation are the alveoli, tiny air sacs where the exchange of oxygen and carbon dioxide takes place.

This inflammation should be helpful as the fluid entering the alveoli is full of white blood cells and disease-fighting components, but too much fluid build-up makes breathing difficult. Some people with COVID-19 need oxygen therapy, or a mechanical ventilator, to help them breathe because of the amount of fluid in their lungs.

There is a delicate balance between reducing inflammation and shutting off the immune system altogether, which is why the use of corticosteroids has been approached carefully.

Cytokine storms

Doctors and researchers are also trying to prevent another type of inflammation. Coronaviruses (including those that cause COVID-19, SARS and MERS) are associated with an immune response called a ‘cytokine storm’. A cytokine is a small protein produced by the body that acts like a messenger between the immune system and immune cells.

When SARS-CoV-2 (the virus that causes COVID-19) enters the body, the immune system reacts by producing cells that will attack the region infected with the virus. These cells are ‘directed by’ cytokines, which trigger inflammation when they are released.

Certain people infected with SARS-CoV-2 release more cytokines than necessary, attracting an oversupply of white blood cells to the area. These white blood cells, in turn, produce more cytokines resulting in a dangerous cycle of inflammation; a cytokine storm. When unchecked, this can result in organ damage, organ failure and possibly death. It is also not yet known why some people have this exaggerated immune response to COVID-19, but research is underway.

A corticosteroid like dexamethasone, that reduces inflammation, could be promising in reducing the effect of this type of event.

 

What did this new research find?

The results of a new study suggested that a low dose of dexamethasone reduced deaths among patients who were seriously ill with COVID-19, ie, those who were unable to breathe without the help of oxygen therapy or a ventilator.

For hospitalised patients with COVID-19 who were well enough to breathe on their own, dexamethasone offered no benefit; in fact there is a possibility that the medicine could have worsened health outcomes for some of those patients.

Keep in mind

In this study, dexamethasone was not used to prevent COVID-19, only to treat it. Healthy people can protect themselves from the viral infection by practicing hygiene, physical distancing and following Australian Government Department of Health advice on limiting social gatherings.

Find out more about how to protect yourself and others from coronavirus (COVID-19)

 

How is dexamethasone different from other treatments?

Dexamethasone is the first treatment to improve survival among those infected with COVID-19.

Remdesivir, an antiviral medicine, was found to shorten recovery time for those hospitalised with COVID-19 but there has been no peer-reviewed research that has shown the medicine to improve survival rates among those infected with COVID-19.

Find out more about antiviral treatment for COVID-19

Another medicine, hydroxychloroquine, has not been found to have beneficial effects for patients with COVID-19.

Find out more about hydroxychloroquine research

 

Should I ask for a dexamethasone prescription just in case?

No. There is nothing in the research to suggest that dexamethasone can prevent COVID-19.

Dexamethasone was not used prophylactically in the study, meaning it was not tested to see whether it prevented the infection, and it should not be used in this way.

It was also shown not to have any benefit for patients with mild to moderate illness who did not need oxygen or a breathing monitor, and there is a possibility that taking the medicine harmed patients in this group. The patients who did respond to dexamethasone were those who developed serious complications from COVID-19 that left them unable to breathe without respiratory support.

Like all medicines, dexamethasone has side effects. If you want to know more about dexamethasone it’s best to speak to your health professional.

 

Staying well during COVID-19

The best way to protect yourself from COVID-19 is to practice good hand hygiene and follow the physical distancing guidelines. It’s also important to stay on top of your physical and mental health during the pandemic.

If you find that you are feeling more anxious during this period it might be a good idea to speak to your regular GP, or a GP at your local clinic about your concerns.