The discovery of the common steroid dexamethasone as a treatment for coronavirus has been hailed as a “major breakthrough” but a Ghanaian Physician Anesthesiologist has warned against self-medicating the cheap and widely available drug.
Having been available for decades, relatively cheap and readily available, Dr Nana Dadzie Ghansah of the Anesthesia Associates of Lexington says even though dexamethasone has been said to help save the lives of patients who are seriously ill with the new coronavirus disease (Covid-19), the drug should not be used in mild cases either.
To him, doing so might weaken the immune system and make one more susceptible to getting a severe form of the disease.
The cheap and widely available dexamethasone drug according to a report by the BBC can help save the lives of patients who are seriously ill with coronavirus.
According to the report, the low-dose steroid treatment is a major breakthrough in the fight against the deadly virus as it cuts the risk of death by a third for patients on ventilators, while it cuts deaths by a fifth for those on oxygen.
It said the drug was part of the world’s biggest trial testing existing treatments to see if they also work for coronavirus.
It said the drug was already being used to reduce inflammation in a range of other conditions, and it appeared to help stop some of the damage that could happen when the body’s immune system goes into overdrive as it tries to fight off coronavirus.
The body’s over-reaction is called a cytokine storm and it can be deadly.
Reaction
But reacting to the development, Dr Nana Dadzie Ghansah explained that preliminary data from the Recovery Trial in Oxford, UK, shows that Dexamethasone reduces mortality in patients with severe COVID-19 significantly and “That is great news.”
“With COVID-19, it is only useful during the cytokine-storm stage of the disease,” he explained.
“So do not self-medicate with dexamethasone as a pre – or post-exposure prophylactic,” he added.
He also advised that it should not be used in mild cases either.
“Doing so might weaken the immune system and make one more susceptible to getting severe form of the disease.”
He explained that treatment is guided by inflammatory markers that are measured in a hospital.
Moreover, after taking it for a while, it cannot be stopped abruptly since that might lead to a life-threatening condition called an Addisonian Crisis, he added.
“So be wise! Do not self-medicate with dexamethasone or any steroid for that matter to prevent or self-treat Covid-19,” he cautioned.
Nana Dadzie Ghansah is a former Assistant Professor of Anesthesiology at the University of Kentucky and also a former Resident Physician at Emory University School of Medicine. He studied Medicine at the University of Leipzig, Germany.
Oxford trial
Meanwhile, according to the BBC report, in the trial, led by a team from Oxford University, around 2,000 hospital patients were given dexamethasone and were compared with nearly 4,000 who did not get the drug.
For patients on ventilators it cut death risk from 40% to 28%. For patients needing oxygen it cut death risk from 25% to 20%.
Chief investigator Prof Peter Horby said: “This is the only drug so far that has been shown to reduce mortality and it reduces it significantly. It’s a major breakthrough.”
Lead researcher Prof Martin Landray says the findings suggest that for every eight patients needing ventilators that you treat, you could save one life.
In patients on oxygen, you save one life for every 20-25 or so treated with the drug.
“There is a clear, clear benefit. The treatment is up to 10 days of dexamethasone and it costs about £5 per patient. So essentially, it costs £35 to save a life. This is a drug that is globally available.”
Prof Landray said, when appropriate, hospital patients should now be given it without delay, but people should not go out and buy it to take at home.
Dexamethasone does not appear to help people with milder symptoms of coronavirus – people who don’t need help with their breathing.
The Recovery Trial has been running since March and included the malaria drug hydroxychloroquine that has now been ditched amid concerns that it increases fatalities and heart problems.
Another drug called remdesivir, an antiviral treatment that appears to shorten recovery time for people with coronavirus, is already being made available on the NHS in the UK.
What is dexamethasone and what has it been used for until now?
A report by Sky News has been explaining the history of the drug, what the research around its effectiveness in COVID-19 patients actually find, and what are its possible side-effects?
It is a widely used steroid drug, known as a corticosteroid, which works to reduce inflammation.
In use since the early 1960s, it treats a range of conditions, including rheumatoid arthritis and asthma.
The drug can work to prevent the immune system from destroying blood platelets in people with blood disorders and is also used in end-of-life care
People with a brain tumour may also be prescribed dexamethasone to reduce swelling around the tumour.
What did the study on coronavirus patients find?
A total of 2,104 patients received 6mg of dexamethasone once a day by mouth or intravenous injection for 10 days.
Researchers then compared their outcomes with those of a control group of 4,321 patients.
They found that – over a 28-day period – the death rate among patients requiring ventilation was 41%, and for those needing oxygen it was 25%.
The figure was 13% among those not requiring respiratory intervention.
However, there was no change in deaths among patients who did not require respiratory support.
How much does it cost?
It is relatively cheap, with researchers putting the cost of a course of treatment for eight people seriously ill with coronavirus at £40.
Dexamethasone is also available globally at cheap prices, allowing lower income countries to benefit.
What are the potential side-effects?
The UK’s National Institute for Health and Care Excellence (NICE) lists the following conditions as common or very common side-effects of all corticosteroids, including dexamethasone:
Anxiety; behaviour abnormal; cataract subcapsular; cognitive impairment; Cushing’s syndrome; electrolyte imbalance; fatigue; fluid retention; gastrointestinal discomfort; headache; healing impaired; hirsutism; hypertension; increased risk of infection; menstrual cycle irregularities; mood altered; nausea; osteoporosis; peptic ulcer; psychotic disorder; skin reactions; sleep disorders; weight increase.
More uncommon side-effects include increased appetite, eye disorders, heart failure, seizure, tuberculosis reactivation and vertigo.
Further warnings around side-effects centre on increased risks associated with prolonged therapy with corticosteroids, which is unlikely to be the case with patients suffering from COVID-19.
However, those taking corticosteroids are advised to take special care to avoid exposure to chicken pox – unless they have previously had the illness – and measles, both of which are believed to place a patient at greater risk.
The NICE guidance also says systemic corticosteroids, particularly in high doses, are linked to “psychiatric reactions including euphoria, insomnia, irritability, mood lability, suicidal thoughts, and behavioural disturbances”
Source: graphic.com.gh with Additional files for this report is from the BBC and Skynews
