- Dexamethasone has been lauded as a breakthrough treatment in the race to cure Covid-19
- Citizens across the world celebrated after it was found to have positive effects in serious cases
- Briefly.co.za lets anaesthesiologist Dr Michael Blackburn explain more about this treatment and what it means for the pandemic
There have been some promising results with respect to the drug Dexamethasone from the recovery trial which is a clinical trial being performed in the United Kingdom to look for drugs which may have use in the treatment of people who have severe Covid-19 disease.
Dexamethasone is a long-acting steroid drug, which has been available for many years. It is by no means a new drug or a breakthrough drug.
It has been used in the treatment of inflammatory conditions and for short term immunosuppression and other specific conditions.
So why should we be excited about dexamethasone?
Some preliminary results from the recovery trial show that the use of dexamethasone in critically ill patients suffering from Covid-19 reduces the likelihood of death and the length of time for which ventilation is needed. It may also decrease the likelihood of requiring ventilation in patients who are already using oxygen therapy in Covid-19 disease.
This sounds great but there are some cautions and caveats.
Firstly, and perhaps most importantly, these are preliminary results and have not been peer-reviewed or published as yet.
This isn’t to say that they are meaningless but that they still need to be reviewed. What is peer review? Before the results of trials are taken into clinical practice they should be assessed by other scientists (i.e not the original investigators).
This is to reduce the chance of statistical errors and bad study design changing clinical practice. This is routine with clinical research. Unfortunately, during the Covid-19 pandemic, there is massive demand from the public for information and hope, and there is always the temptation to release trial results before they have been reviewed.
Of course, if the results are so significant that they could not have occurred by chance alone, then it is reasonable to report these. It remains to be seen into which category these results fall.
Secondly, this treatment is only for critically ill patients on the prescription of intensive care physicians. This medication has no role in the prevention of Covid nor the treatment of mild disease.
Systemic steroids are not without side effects which can include water retention, hyperglycaemia, adrenal suppression, depression and skin changes amongst others. In particular, if you suffer from any chronic medical condition, treatment with steroids may worsen your disease.
It is also worth noting that steroid treatment in the context of critical illness remains very controversial - steroids have come in and out of favour for many years now amongst intensive care physicians.
Please don't ask your GP to prescribe dexamethasone for you, or go to your pharmacist and ask for dexamethasone. It remains only for use in the critically ill. This is a rapidly evolving space.
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