Healthcare experts in the U.K. have decided to administer dexamethasone, a steroid treatment to seriously ill Coronavirus patients, claiming it as a breakthrough to help reduce the death toll of the ongoing global pandemic, though the same drug failed to yield good results and was proved uncertain for sore throat just three years ago.
Recently, researchers led by a team from the University of Oxford administered the widely available steroid dexamethasone to more than 2,000 severely ill Coronavirus patients, which included those who could only breathe with the help of a ventilator. Later, they found that dexamethasone reduced deaths by 35 percent.
Steroid Treatment: Role of Dexamethasone
Peter Horby, professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford said that the steroid is the first drug that improved survival in Coronavirus and results are "extremely promising." He added, "Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide." Meanwhile, U.K. Health Secretary Matt Hancock said that the Coronavirus patients would start to receive the drug immediately.
The steroid drug is the part of the world's biggest trial testing existing treatments to determine whether it will work against the SARS-CoV-2. The researchers claimed that if the steroid had been used to treat patients in the U.K. from the start of the pandemic, up to 5,000 lives could have been saved. They also claimed that it could be of huge benefit in poorer countries with high numbers of infection cases.
The WHO head Tedros Adhanom Ghebreyesus congratulated the University of Oxford and the Government of the U.K. for the new finding using steroid medication and appreciated the contribution of hospitals and patients while addressing dexamethasone as a "lifesaving scientific breakthrough."
2017 Study Shows a Different Scenario
To know more about the use of this drug and its effectiveness, it is necessary to take look at an earlier study where researchers used dexamethasone, which is a type of corticosteroid medication, to cure sore throat which is also a particular symptom of Coronavirus. As per the results published by JAMA, it is claimed that the acute sore throat is one of the most common symptoms among patients visiting the primary care centers.
The study, published in 2017, showed that a single capsule of the dexamethasone didn't increase the likelihood of complete symptom resolution after 24 hours, but more patients reported feeling completely better after 48 hours, indicating the role of steroids to treat sore throats as uncertain, said the team.
Under this experiment, Gail Hayward of the University of Oxford and his colleagues randomly assigned adults with a sore throat to provide each participant with a single oral dose of 10 mg of dexamethasone or placebo. The trial was conducted in 42 family practices in South and West England, involving 565 eligible randomized participants.
Among all these participants (median age, 34 years), 288 people received the steroid drug, while 277 were given the placebo. The researchers then found that at 24 hours, participants receiving dexamethasone drug were not more likely than those receiving placebo to have complete symptom resolution. They also noticed that the results were similar among those who were not offered an antibiotic prescription and those who were offered a delayed antibiotic prescription.
However, at 48 hours, more participants who received the steroid drug than placebo -- 35 percent versus 27 percent -- had complete symptom resolution which was also observed in patients not offered delayed antibiotics. But as per the researchers, they did not find any significant difference in other outcomes such as days missed from work or school and adverse events.
The study author noted that corticosteroids may have clinical benefits in addition to antibiotics for severe sore throat, for example, to reduce hospital admissions of those patients who are unable to swallow fluids or medications.
2012 Study on Children
Corticosteroids are often given to children undergoing tonsillectomy to reduce postoperative nausea and vomiting; but a 2012 research paper had suggested that corticosteroids may increase the risk of hemorrhage during and after surgery.
The study published in the September 26 issue of JAMA, suggested that a single dose of intraoperative dexamethasone significantly increased post-tonsillectomy hemorrhage events. "In light of these findings, there is a need to reassess the safety profile for dexamethasone when used during tonsillectomy," the authors wrote based on the findings of their study conducted between July 2010 and December 2011 with 14-day follow-up. "Increased subjective (level 1) bleeding events caused by dexamethasone could not be excluded because the noninferiority threshold of 5 percent was crossed," the authors wrote.