20 July 2020 Blog Post: Dexamethasone Improves Survival in Severe COVID-19

In some good COVID-19 news, preliminary results from a UK study showing a survival benefit with dexamethasone treatment in severe COVID-19.

A total 6400 patients hospitalized with COVID-19 were studied. One group of 4300 patients received “usual care” (i.e. supportive measures ranging from supplemental oxygen to breathing assistance with a ventilator). Another group of 2100 patients received usual care plus dexamethasone (6 mg once daily for up to 10 days delivered by mouth or intravenously).
 
Dexamethasone (Decadron) is a corticosteroid hormone (glucocorticoid which serves most often to decrease the body’s natural defensive response and reduces symptoms such as swelling and allergic-type reactions. It has a wide rang of uses including treatment of arthritis, blood/hormone/immune system disorders, allergic reactions, certain skin and eye conditions, breathing problems, certain bowel disorders, and certain cancers. I use it most often in my practice in severe asthma exacerbations or allergic reactions that have impacted swallowing or breathing.
 
The most striking difference of dexamethasone use in COVID-19 cases was seen among patients on a ventilator at the time they received the medication. The mortality rate within 28 days was significantly lower in the dexamethasone group than among the “usual care” group (29% vs. 41%). A benefit was also seen among those on supplemental oxygen without invasive ventilation (mortality rate: 23% vs. 26%). However, among patients not receiving any respiratory support, mortality rates did not differ significantly between treatment groups.
 
It is not coincidental that these early studies are from the UK – a country which has a single payor medical system. While the US is certainly capable of performing such investigations, the ability to collaborate quickly and generate an adequately sized study population is hamstrung by our multiple and non-communicative health systems.
 
It was also interesting to see that the accompanying editorial was written by Drs. H. Clifford Lane and Anthony Fauci of the National Institute of Allergy and Infectious Diseases. Dr .Fauci was characterized as “a little bit of an alarmist” by President Trump this weekend.
 
But Dr. Fauci’s comments on this groundbreaking study that will now change our standard of care in severe COVID-19 cases were anything but alarmist. He noted, that the findings provided “clarity to an area of therapeutic controversy and probably will result in many lives saved.”

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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