U.K. researchers released what they called “groundbreaking” news Tuesday regarding dexamethasone, a low-cost steroid they claim may prevent one in eight deaths of ventilated patients with COVID-19. In the midst of a pandemic that has infected more than 8 million people worldwide, it’s undoubtedly encouraging news. But in the wake of premature endorsements of hydroxychloroquine and other treatments, experts are urging both doctors and the public to proceed with caution.
“The idea that this works is good, but we need to see the data,” says Yahoo Life Medical Contributor Dr. Dara Kass, noting that the study has yet to be released. “This is more of a confirmation of something that we believed would work with what we hope is good science, but we haven’t seen it yet.”
The study — conducted by researchers from Oxford University — does seem to align with what’s known as the “gold standard” of research, meaning it was a randomized controlled trial of the drug. It was conducted through a program called Recovery (“Randomized evaluation of COVid-19 thERapY”), in which 2,104 COVID-19 patients who received dexamethasone were compared with 4,321 patients who did not. The drug reportedly reduced deaths by one-third in patients who were on a ventilator and by one-fifth in patients receiving oxygen alone. It did not have an effect on those without oxygen support.
“Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result,” said Peter Horby, lead investigator on the study and professor of emerging infectious diseases at the University of Oxford, in the Recovery press release. “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become the standard of care in these patients.”
The drug itself falls into a class of medicines called corticosteroids, which are anti-inflammatory drugs used to treat conditions ranging from strep throat to arthritis. Dr. James Cutrell, an infectious disease specialist at the University of Texas Southwestern, agrees that without more information it’s hard to know exactly what the researchers found. But given that it specifically affects those who are severely ill, he suggests that it’s likely diminishing the life-threatening immune reaction known as a “cytokine storm.”
“Our body makes its own natural steroid, kind of your adrenaline or stress hormone, but these are synthetic steroids that have a wide range of effects on dampening the immune system or modifying the inflammatory state within the body,” Cutrell explains to Yahoo Life. “Patients who are sick with COVID-19, their body, in an attempt to fight off the virus, is in this hyperinflamed state that’s causing damage to other parts of the body. So presumably the way that [dexamethasone] is helping is to kind of tamp down or reduce that inflammation.”
Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, didn’t find the news particularly surprising. “We’ve known for a while that this disease has a lot to do with your immune reaction to the virus,” Adalja tells Yahoo Life. “And we’ve been seeing some benefit in severe patients with other immune-modulating drugs.” He notes that an important thing to consider is that the authors only noted effects among those who were critically ill and required oxygen or ventilation.
“It does look promising, but you have to remember this isn’t for every person; it’s for individuals who have the need for hospitalization and the need for oxygen therapy or mechanical ventilation to get their mortality down,” says Adalja. “This is not a pill that people who are mildly ill are going to take to decrease their contagiousness or prevent them from going to the hospital. That drug would be the actual game changer.”
Kass agrees, noting that the vast majority of patients with COVID-19 don’t need mechanical ventilation or hospitalization, and thus aren’t candidates for this medication. On top of that, she notes that the drug doesn’t actually treat the virus. “This drug isn’t addressing the coronavirus at all; it’s a nonspecific anti-inflammatory,” says Kass. “It’s not a miracle drug. We don’t want to overinterpret this.”
William Schaffner, an infectious disease expert at Vanderbilt School of Medicine, isn’t ready to make assumptions either, but remains cautiously optimistic about the news. “Among these very, very sick people, dexamethasone — a steroid that we have long used in medicine and with which we are very familiar — seems to have benefit,” he says. “Once we see the data, I think it will have the potential for changing practice and giving doctors an option.”
Much like the other experts, he urges Americans not to consider this license to abandon safety protocols. “It won’t change anything about the people who need treatment. Prevention comes before treatment, and the stream of patients coming in requiring treatment will continue unless we can do the social distancing, the wearing of the masks, the avoiding of large group events that are so important,” he says. “It’s great ... that it’s a drug that can help people survive, but we’d like to reduce the number of people that need it.”
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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