7 Things You Should Know About the Cheap Drug That Fights Covid-19
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There's a lot of enthusiasm about an inexpensive drug that appears to help save the lives of the sickest people with Covid-19. Here's what you need to know about dexamethasone now.
Just as enthusiasm for hydroxychloroquine as a Covid-19 treatment waned after reports that the risks outweighed the benefits, new research suggested that an inexpensive, widely used steroid may help the sickest Covid-19 patients.
And although it was just one promising study, many doctors are cautiously optimistic that this steroid, dexamethasone, may save lives among Covid-19 patients who require mechanical help to breathe.
“This is, so far, the most potentially important result we have in the treatment of severe Covid-19. Dexamethasone is the first therapy that looks like it will reduce death,” says Charles Hennekens, MD, DrPH, the Sir Richard Doll professor and senior academic advisor to the dean of the Charles E. Schmidt College of Medicine at Florida Atlantic University in Boca Raton.
Here are some things you should know about dexamethasone:
Dexamethasone is used often in the ER
Dexamethasone is a steroid that is often used to cool inflammation and treat certain types of arthritis. It is given in the emergency room if someone comes in with swelling or swelling of the throat, tongue, or lips, says Robert Glatter, MD, an emergency physician in New York City.
University of Oxford researchers in England found that dexamethasone was able to reduce deaths by one-third in people with Covid-19 who required a ventilator and by one-fifth in those who needed oxygen. Put another way, the drug would prevent one death for every eight patients on ventilators and for every 25 patients requiring oxygen alone, the researchers point out.
These are the sickest of the sick. As many as 88 percent of people who need mechanical devices like respirators to help them breathe will die, according to a study published in April in JAMA, one of the largest reviews published to date of Covid-19 patients hospitalized in the United States.
“The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients,” says Peter Horby, professor of emerging infectious diseases in the Nuffield Department of Medicine at the University of Oxford, in a news release. He is one of the lead investigators for the study. This study is one arm of the RECOVERY (Randomised Evaluation of Covid-19 Therapy) trial, which looks at a range of potential treatments for COVID-19.
This widely available treatment may have saved Dr. Scott Ira Krakower‘s life. Dr. Krakower, 40, unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, New York, developed Covid-19 in April. It started when he lost his sense of taste and smell, and progressed dramatically within a week. Losing your sense of taste and smell are among the telltale symptoms of Covid-19.
“I was coughing up blood and my throat was swelling up to the point that I couldn’t breathe, and I was admitted to the hospital,” he recalls. Dr. Krakower received intravenous dexamethasone along with supplemental oxygen as part of his care.
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Dexamethasone is low-cost, works fast, and lasts long
The UK government approved the use of dexamethasone for Covid-19 after these study results were released. Beginning June 16, the standard treatment for Covid-19 will include dexamethasone, helping save thousands of lives, Health Secretary Matt Hancock said.
Dexamethasone is inexpensive, on the shelf, and can be used immediately, says Dr. Horby. It’s a generic medication, which makes it less expensive than brand-name drugs, which cost hundreds of millions of dollars to manufacture. The cost of treating eight people with dexamethasone would be about $50.
Dexamethasone acts rapidly, explains Dr. Glatter. “It typically takes a few hours to begin to work.” This was true for Dr. Krakower. “I felt like I started turning the corner right after I got the steroids,” he says. “After an hour, I stopped coughing and the intensity of the sickness wasn’t nearly as bad as before I started the IV steroid.” Krakower was released from the hospital after a few days and is currently taking steroids to treat his cough, which has returned.
Once it has kicked in, the effects of dexamethasone last more than 50 hours, Dr. Glatter says.
Dexamethasone has side effects
Caution is needed, says Dr. Glatter. “It’s an interesting study, and we will have to see what the full data shows,” he says. “It’s encouraging, but we need to be careful when we promote a treatment as a standard of care during Covid-19 since things are evolving rapidly. The science is sound, but caution is the word.”
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How dexamethasone works
This drug doesn’t stop the coronavirus, called SARS-CoV-2, from reproducing, says Dr. Hennekens. “Dexamethasone diminishes inflammation in the lungs so they are less damaged and less prone to irreparable damage that would cause respiratory distress and death.”
Other treatments that attack the virus and reduce the chances of dying from it are needed, Dr. Hennekens says. An antiviral drug called remdesivir, which was developed to thwart Ebola and related viruses, is promising, he notes. The Food and Drug Administration (FDA) granted emergency use authorization for the drug in treating Covid-19. Israel also just approved the use of remdesivir for coronavirus infections. “It is still unproven, and we don’t know if it reduces risk of dying from Covid-19 yet,”Dr. Hennekens says.
You shouldn’t take dexamethasone to prevent Covid-19
Steroids have known side effects, and doctors should not be prescribing dexamethasone to individuals concerned about getting Covid-19, says E. Neil Schachter, MD, a professor of medicine, pulmonary, critical care, and sleep medicine at The Mount Sinai Hospital in New York City and author of The Good Doctor’s Guide to Colds and Flu. “They haven’t shown that this is helpful to take at first sign of infection. You have to be really sick to take this drug and potentially see a benefit.”
It’s also not recommended as a first-line treatment for people who do get the infection. For most people, the first five to 10 days of the disease aren’t too bad, Dr. Schachter says. “Don’t rush to hospital if you are feeling OK and not getting worse,” he says. “Hunker down at home and watch for complications.” Drink enough fluids, get rest and take medication to reduce any fever, he adds.
Other steroids may make Covid-19 symptoms worse
The jury is still out on whether other types of inflammation-fighting steroids will help. Some studies have shown that people who take moderate- to high-dose steroids are more likely to have a severe Covid-19 disease course, Dr. Schachter says.
They are often taking steroids to treat an underlying condition, and steroids can suppress your immune system, leaving you more vulnerable to infection, he notes.
- Charles Hennekens, M.D., DrPH, Sir Richard Doll professor and senior academic advisor to the dean, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
- Robert Glatter, MD, emergency physician, New York City
- University of Oxford: "Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19"
- JAMA: "Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area"
- Scott Ira Krakower, DO, unit chief, psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York.
- Government of the United Kingdom: "World first coronavirus treatment approved for NHS use by government"
- American Society of Health-System Pharmacists: "Dexamethasone"
- Israel Prime Minister's Office: Cabinet Approves Health Minister's Decision on Remdesivir
- E. Neil Schachter, MD, professor of medicine, pulmonary, critical care and sleep medicine, The Mount Sinai Hospital, New York City; author of The Good Doctor's Guide to Colds and Flu.