An effective vaccine against the SARS-CoV-2 virus currently fueling our pandemic won’t likely arrive until a year from now. Having said all of that, there are plenty of promising developments being achieved on the therapeutics front.
Recently, researchers officially hailed dexamethasone (a cheap, widely available corticosteroid) as a powerful reducer of COVID-19 related deaths. Although limited to critical cases, experts have been quick to characterize the results as “a breakthrough” in our fight against a remarkably sophisticated pathogen.
“If they hold up,” said Devi Sridhar, an expert on global public health at the University of Edinburgh, “they could be a game-changer for critical patients, as the drugs are accessible even in lower-income countries.”
“The results are pretty remarkable for severely ill patients,” Nahid Bhadelia, a physician at Boston Medical Center added in a media release. “I can see ICU [intensive care unit] physicians being more likely to provide steroids in the critically ill who are mechanically ventilated and who are not improving from other interventions based on these results.”
The report followed a major clinical recovery trial conducted on severely ill coronavirus patients. The Recovery trial included an experiment group comprising 2,104 coronavirus patients.
Each was given a low 6-milligram dose of dexamethasone over the course of 10 days. After comparing the results of the experiment group with that of the control group, who received standard supportive care, dexamethasone was determined to reduce COVID-19 related deaths by one-third in patients already placed on ventilators and by one-fifth in critical patients who were receiving some other form of supplemental oxygen at the time of analysis.
“These are really surprising, but really very convincing results,” exclaimed Martin Landray of the University of Oxford, who was one of the principal investigators of the Recovery trial in the United Kingdom that evaluated the steroid.
It should be noted that the researchers did not find any benefit in patients not receiving respiratory support. In other words, the “breakthrough” might excessively benefit the critically ill.
Virologists still maintain that around 80% of otherwise healthy coronavirus carriers will not require medical attention, but that qualifier still leaves a considerable portion of the global population susceptible to fatal manifestations of the respiratory disease caused by the virus.
“Overall dexamethasone reduced the 28-day mortality rate by 17% with a highly significant trend showing greatest benefit among those patients requiring ventilation,” the authors in the new report. “But it is important to recognise that we found no evidence of benefit for patients who did not require oxygen and we did not study patients outside the hospital setting. Follow-up is complete for over 94% of participants. “
On balance, the pharmusical countermeasures developed to address COVID-19 can be categorized via three primary objectives: Accelerate viral clearance, attend disportionately affected populations, and protect important biological autoimmune functions.
As you know, very few trial drugs have appeased all three conderations. Steroids are powerful agents as far as attacking viral material, but the outlay is sometimes a weakened immune response.
Previously conducted studies have yielded adverse outcomes in patients with respiratory infection receiving steroid treatment, though the mechanisms were unclear.
These trials recruited critically ill patients who were already fighting immense odds before the study even started.
Followup analysis not only eliminated corticosteroid as an aggravator, the steroid seemed to demonstrate it’s influence as a mitigator of serious COVID-19 symptoms.
Carlos Ferrando, an anesthesiologist at the Hospital Clinic of Barcelona, co-authored a paper recently published in the Lancet Respiratory Medicine journal that showed dexamethasone successfully reduced mortality in non–COVID-19 patients suffering from acute respiratory distress syndrome—which itself is a reliable contributor to coronavirus deaths.
Roughly 80% of patients in Spanish Health Systems receive some kind of steroid regimen for viral infections.
“It seems like we have a signal that those corticoids decrease mortality, but we need to finalize the analysis.”
CW Headley is a reporter for the Ladders and can be reached at email@example.com