Skip to main content

New story in Health from Time: A Cheap, Common Steroid Called Dexamethasone May Help Patients With Severe COVID-19, Study Says



A paper published Friday in the New England Journal of Medicine suggests a low-cost steroid may be a valuable treatment for severe COVID-19, building upon encouraging preliminary findings from last month.

In June, U.K. researchers reported that dexamethasone—a cheap, widely available steroid that can lower inflammation in the body—appeared to reduce by a third the risk of death among patients with severe COVID-19. U.K. practitioners began using dexamethasone the very same day the results were announced, but some medical experts were more guarded, arguing no conclusions should be made without seeing the trial’s full results.

Those results were published today in NEJM, and they seem to support what was announced last month. Dexamethasone did have a measurable benefit for COVID-19 patients sick enough to require respiratory support—but it had no such benefit, and even showed the potential for some possible harm, for patients with milder disease.

About 2,100 people hospitalized for confirmed or suspected COVID-19 were randomly assigned to receive a 10-day course of dexamethasone in addition to standard COVID-19 care, while about 4,300 received standard care alone. Around 16% of the patients (overall, both those given dexamethasone and those who were not) were receiving mechanical ventilation, 60% were receiving oxygen only and 24% were not getting any breathing support.

After 28 days, 482 patients taking dexamethasone had died, compared to about 1,110 of the patients not taking it. That means about 23% of the dexamethasone patients died, compared to about 26% of the other patients.

That may not seem like a terribly significant difference, but the researchers found a sizable benefit for the sickest patients in the sample: those requiring mechanical ventilation to survive. About 30% of these patients died on dexamethasone, compared to 41% of those not taking it. A smaller, but still significant, benefit was also seen for patients receiving oxygen without invasive ventilation.

Meanwhile, dexamethasone provided no benefit for patients who did not require breathing support. In fact, among patients with these milder cases, those taking dexamethasone were actually more likely to die—about 18% of them did, compared to 14% of those receiving standard care alone.

Logically, the anti-inflammatory drug seemed to work best in patients who had the most inflammation. Patients who had suffered symptoms for at least a week—and thus likely had developed some inflammatory lung damage—seemed to do better on the steroid than patients with newer symptoms, who may not have experienced much inflammation.

“It is likely that the beneficial effect of glucocorticoids [like dexamethasone] in severe viral respiratory infections is dependent on selection of the right dose, at the right time, in the right patient,” the researchers write in the paper. “High doses may be more harmful than helpful, as may such treatment given at a time when viral replication is paramount and inflammation is minimal.”

While the paper’s publication is an encouraging step forward, the preliminary research must still be validated and replicated by other investigators. The researchers also note that, because they aimed to release results as soon as possible to meet demand for new therapies, they did not collect some data on secondary and long-term outcomes.

Labels:

Popular posts from this blog

New story in Health from Time: Here’s How Quickly Coronavirus Is Spreading in Your State

The novel coronavirus pandemic is a global crisis, a national emergency and a local nightmare. But while a great deal of the focus in the U.S. has been on the federal government’s response, widely criticized as slow and halting , the picture on the ground remains very different in different parts of the country. A TIME analysis of the per capita spread of the epidemic in all 50 states and Washington, D.C. found considerable range in the rate of contagion, and, in some parts of the country, a significant disparity compared to the national figure. The U.S., unlike nations such as South Korea and now Italy , has yet to show signs of bringing the runaway spread of the virus under control. However, while no single state is yet showing strong signs of bending the curve , some are faring much worse than others. The following graphic plots the rise in the total confirmed cases of COVID-19 per 100,000 residents in each state, plotted by the day that each state reported its first case.
Read more

New story in Health from Time: We Need to Take Care of the Growing Number of Long-term COVID-19 Patients

On July 7, 2020, the Boston Red Sox pitcher Eduardo Rodriguez tested positive for the new coronavirus. He was scheduled to start Opening Day for the Sox, but the virus had other plans— damaging Rodriguez’s heart and causing a condition called myocarditis (inflammation of the heart muscle). Now the previously fit 27-year old ace left-hander must sit out the 2020 season to recover. Rodriguez is not alone in having heart damage from SARS-CoV-2, the virus that causes COVID-19. In a new study done in Germany, researchers studied the hearts of 100 patients who had recently recovered from COVID-19. The findings were alarming: 78 patients had heart abnormalities, as shown by a special kind of imaging test that shows the heart’s structure (a cardiac MRI), and 60 had myocarditis. These patients were mostly young and previously healthy . Several had just returned from ski trips. While other studies have shown a lower rate of heart problems—for example, a study of 416 patients hosp
Read more

New story in Health from Time: What We Don’t Know About COVID-19 Can Hurt Us

Countries around the world have introduced stringent control measures to stop COVID-19 outbreaks growing, but now many find themselves facing the same situation again. From Melbourne to Miami, the relaxation of measures had led to increasing flare-ups, which in some places has already meant reclosing schools, businesses or travel routes. Within the U.S. and among different countries , places with wildly varying public-health policies have experienced wildly diverse outcomes. Most ominously, infections are rising rapidly in many places where they once were falling. So how do countries avoid an indefinite, unsustainable, cycle of opening and closing society? What is needed to prevent a future of strict social distancing and closed borders? To escape this limbo, we need to know more about each step in the chain of infection: why some people are more susceptible or have more symptoms, how our interactions and surroundings influence risk, and how we can curb the impact of the re
Read more