{"id":32670,"date":"2020-06-19T08:14:49","date_gmt":"2020-06-19T14:14:49","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=32670"},"modified":"2022-04-13T10:03:38","modified_gmt":"2022-04-13T16:03:38","slug":"dexamethasone-may-or-may-not-be-a-breakthrough-coronavirus-treatment","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/dexamethasone-may-or-may-not-be-a-breakthrough-coronavirus-treatment\/","title":{"rendered":"Dexamethasone may or may not be a breakthrough coronavirus treatment"},"content":{"rendered":"
<\/div>
\"Covid-unit
A British study\u2019s preliminary results indicate that an old, inexpensive corticosteroid (Dexamethasone) may do more to save acute coronavirus patients than anything medical science has found so far. Will it be a major breakthrough? Photo by Joel Blocker, for UCHealth.<\/figcaption><\/figure>\n

When an old drug made big news on June 16, it came to no surprise to a young UCHealth physician.<\/p>\n

The drug was dexamethasone. It was first approved in October 1958 when Dwight Eisenhower was president, NASA was born, and Pan Am flew the first commercial flight across the Atlantic.<\/p>\n

The news this month was a major British study\u2019s preliminary findings<\/a> that seriously ill COVID-19 patients who received dexamethasone, a corticosteroid, had a 35% better survival rate than patients who did not receive the drug. In the face of growing doubts<\/a> about the effectiveness of hydroxychloroquine against the disease, the apparently modest<\/a> improvement of patients who receive the antiviral remdesivir, and the lack of other proven coronavirus therapies, the British study\u2019s preliminary findings were a rare ray of light amid a therapeutic outlook stuck in a predawn gray.<\/p>\n

The young physician is Dr. Josh Douin<\/a>, and he wasn\u2019t surprised because he and other intensive-care physicians at UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a> have been giving intravenous dexamethasone to seriously ill coronavirus patients since the dawn of the Colorado outbreak three months ago. Douin, a University of Colorado School of Medicine anesthesiologist and critical-care medicine specialist, has in fact proposed, with virologist Dr. Thomas Campbell<\/a> and Emergency Medicine physician Dr. Adit Ginde<\/a>, a clinical trial to quantify the safety and effectiveness of dexamethasone on COVID-19 patients.<\/p>\n

Calming the storm<\/strong><\/h3>\n

Douin joined many in the medical community in advising caution with respect to the British study\u2019s initial report, which came in the form of a press release. It could well be, for example, that the patients who received dexamethasone weren\u2019t as sick as those who didn\u2019t, or that the study had other potential flaws, he says.<\/p>\n

\"A
Dr. David Josh Douin, who discusses if dexamethasone is a breakthrough coronavirus treatment.<\/figcaption><\/figure>\n

\u201cDistributing via press release is no substitute for a peer-reviewed article,\u201d he said.<\/p>\n

That said, Douin and others recognize dexamethasone\u2019s long-recognized ability to settle down the immune system, and that the drug\u2019s immunosuppressive effect might quell the hyperinflammation caused by the body\u2019s immune response to the coronavirus. The medical community increasingly recognizes cytokine storm<\/a>-triggered autoimmunological assaults as the primary culprits in the most serious coronavirus cases. Those inflammatory attacks can target not only<\/a> the lungs, but also the heart, brain, gastrointestinal tract, kidneys, and blood.<\/p>\n

The British team is well-respected, and the study design as well as the large number of participants bolster hopes that the findings will hold up. The team\u2019s chief investigators say they went public prior to peer-reviewed publication because the patients who got dexamethasone did so much better than those not receiving the drug \u2013 to the point that the investigators halted the trial on June 8 and got the word out as quickly as they could.<\/p>\n

The study involved 2,104 patients who received 6 milligrams of intravenous dexamethasone once a day for 10 days. When the team compared outcomes at 28 days with those of 4,321 patients who received usual care, the researchers found deaths among patients on ventilators to be 35% lower and deaths among patients requiring oxygen only to be 20% lower than the control group. Patients who didn\u2019t require respiratory support fared no better or worse on the drug, the team found.<\/p>\n

Douin describe the results as \u201cvery promising,\u201d all the more so because dexamethasone is widely available, widely used, and cheap: the medical course the British study used would cost about $50, he said.<\/p>\n

Hope @ UCHealth<\/strong><\/h3>\n

While dexamethasone hasn\u2019t yet been formally studied with coronavirus patients at UCHealth University of Colorado Hospital, many patients have received it, Douin says. The impetus was a Spanish-led study<\/a> published in February that showed marked improvement among patients with acute respiratory distress syndrome (ARDS<\/a>). That disease has many triggers, COVID-19 among them. Douin described a 34-year-old patient who, given a 20-milligram dose of dexamethasone on each of the first five days and 10-milligram doses on days six through 10 (the treatment regimen outlined in the Spanish study) turned around quickly. Douin cautions that, while dexamethasone seems also to have benefitted a handful of other patients, some of the UCHealth ICU patients who received the corticosteroid later died, too.<\/p>\n

\u201cI suspect it\u2019s helping, but my suspicions are not gold-standard evidence, and they\u2019re not a clinical trial,\u201d Douin said.<\/p>\n

The British dexamethasone announcement came as researchers around the world study whether existing drugs<\/a> known to tamp down unwanted immune responses may shelter COVID-19 patients from cytokine storms. Some are broad-based anti-inflammatories; some target particular cytokines such as interleukin-6 and interleukin-1. One of those drugs, the IL-1 receptor antagonist anakinra<\/a>, was developed based on pathbreaking research by the late University of Colorado School of Medicine immunologist William Arend.<\/p>\n

Given that dexamethasone has been on the job for 62 years, it\u2019s well understood, Douin says. It\u2019s given to the vast majority of UCHealth surgery patients as a nausea suppressant, and it\u2019s used to treat edema and swelling and also as a pain-reducer for cancer patients, he says. That dexamethasone is also a mainstay for patients after cataract eye surgery<\/a> hints at the drug\u2019s versatility.<\/p>\n

The drug can have serious side-effects also, though, Douin says: it can increase blood sugar to the point that insulin is required, and it can cause muscle weakness and neuropathy. As advertised, dexamethasone also suppresses the immune system, which can slow wound healing and hinder the body\u2019s ability to fight infection.<\/p>\n

That last side effect of corticosteroids, Douin says, led to initial caution with respect to dexamethasone and its brethren as COVID-19 treatments. Patients with viral pneumonia caused by SARS and MERS coronaviruses had a harder time clearing the virus when on corticosteroids and fared no better than patients without the corticosteroids.<\/p>\n

As Douin and physicians around the world await the British team\u2019s peer-reviewed report (he expects it may be published in the next four to six weeks), UCHealth will continue to treat its most serious patients as it has been doing \u2013 including with dexamethasone.<\/p>\n

Douin is hoping the study lives up to the press release.<\/p>\n

\u201cI think this is a new tool that gives us hope, and it\u2019s one more thing we can use for the sickest patients with COVID-19,\u201d he said.<\/p>\n","protected":false},"excerpt":{"rendered":"

When an old drug made big news on June 16, it came to no surprise to a young UCHealth physician. The drug was dexamethasone. It was first approved in October 1958 when Dwight Eisenhower was president, NASA was born, and Pan Am flew the first commercial flight across the Atlantic. The news this month was […]<\/p>\n","protected":false},"author":23,"featured_media":32680,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[4859,4860,162,4781],"class_list":["post-32670","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-coronavirus","tag-covid-19","tag-infectious-diseases","tag-research-in-health-care"],"acf":[],"yoast_head":"\nIs dexamethasone a breakthrough coronavirus treatment? - UCHealth Today<\/title>\n<meta name=\"description\" content=\"First approved in 1958 when NASA was born and Pan Am flew the first commercial flight across the Atlantic. 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He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado, where he was a Ted Scripps Fellowship recipient in Environmental Journalism. He is author of \u201cA Beard Cut Short,\u201d a biography of a remarkable professor; \u201cThe Laser That\u2019s Changing the World,\u201d a history of lidar; and \u201cFrom Jars to the Stars,\u201d a history of Ball Aerospace.","url":"https:\/\/www.uchealth.org\/today\/author\/tneff\/"}]}},"coauthors":[{"id":23,"name":"Todd Neff","link":"https:\/\/www.uchealth.org\/today\/author\/tneff\/"}],"_links":{"self":[{"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/posts\/32670","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/users\/23"}],"replies":[{"embeddable":true,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/comments?post=32670"}],"version-history":[{"count":6,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/posts\/32670\/revisions"}],"predecessor-version":[{"id":32681,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/posts\/32670\/revisions\/32681"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/media\/32680"}],"wp:attachment":[{"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/media?parent=32670"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/categories?post=32670"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.uchealth.org\/today\/wp-json\/wp\/v2\/tags?post=32670"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}