The British trial of dexamethasone steroids was announced on Friday. The long-awaited complete results confirm its life-saving benefits for COVID-19 patients on ventilators, but it is recommended that premature administration may cause harm.
A total of 2104 inpatients were assigned to receive 6 mg of drug therapy per day for up to 10 days, and 4,321 patients received conventional treatment. The mortality rate was compared with the mortality rate after 28 days.
Among patients who used ventilators, the mortality rate of patients who used drugs was 29.3%, while those who did not use ventilators were 41.4%.
In other words, the mortality rate in this group decreased by 29%, less than one-third.
Among patients who received oxygen but obtained it in a less invasive way, the benefit was smaller-23.3% of dexamethasone deaths compared to 26.2% of unused dexamethasone.
However, there was no benefit in the group that did not receive any oxygenation at the beginning of the trial.
In this cohort, the proportion of steroid deaths was 17.4%, while the proportion of non-steroids was 14%, indicating that the drug increased its risk of death.
This is because the drug works by suppressing the abnormal immune response that damages human organs rather than attacking the virus.
In a speech to AFP in June, the leading American scientist Anthony Fauci warned that dexamethasone should not be taken out prematurely after being infected.
“It had no effect, if not maybe even a suggestion of making things worse early on,” he said.
“This is perfectly compatible with knowing that early on in infection, you need the immune system to suppress the virus.”
The authors of the paper, which appeared in the New England Journal of Medicine, added that getting benefit from the drug “is dependent on a selection of the right dose, at the right time, in the right patient.”
They added that for COVID-19 disease, for patients who need oxygen, the abnormal immune response seems to be more harmful than causing the virus to replicate in the body.
But they warned that without further research, the hypothesis should not be applied to other viral respiratory diseases, such as SARS, MERS and influenza, because they may have different effects.
Dexamethasone was accepted by the UK on June 16 (the day when the preliminary results were announced) and was recommended by the National Institutes of Health.
NIH warns on its website that it is not known how effective the combination of dexamethasone and the antiviral drug ramcivir is.
It added that patients taking the drug should be closely monitored for secondary infections and hyperglycemia.
It is also known that the use of corticosteroids can also reactivate previously dormant infections, such as hepatitis B virus or tuberculosis.