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Rheumatoid arthritis

Coronavirus: What is dexamethasone and how does it work?

A few weeks ago the British media announced that Dexamethasone, an existing drug (normally used to treat diseases like rheumatoid arthritis, asthma, serious allergies, etc.), had been found to work on patients who are very ill with Coronavirus, which often triggers inflammation all over the body. Dexamethasone helps calm this inflammation.


An anti-inflammatory drug called dexamethasone has been hailed as a ground-breaking treatment for hospital patients seriously ill with Covid-19.

A UK trial showed the drug could save lives – the first internationally to do so – and it can be used in the NHS immediately.

What is the drug?

Dexamethasone is a steroid – a medicine that reduces inflammation by mimicking anti-inflammatory hormones produced by the body.

How does it work?

This drug works by dampening down the body’s immune system.

Coronavirus infection triggers inflammation as the body tries to fight it off.

But sometimes the immune system goes into overdrive and it’s this reaction that can prove fatal – the very reaction designed to attack infection ends up attacking the body’s own cells.

Dexamethasone calms this effect.

It’s only suitable for people who are already in the hospital and receiving oxygen or mechanical ventilation – the most unwell.

The drug does not work on people with milder symptoms, because suppressing their immune system at this point would not be helpful.

How patients on ventilators would fare on dexamethasone

BBC

How effective is it?

According to the scientists who carried out the trials, one in three deaths could be prevented among patients on ventilators.

For patients on oxygen, it could prevent one death in five.

There was no significant benefit for patients who were not receiving respiratory support.

What was the trial?

The results come from the Recovery (Randomised Evaluation of Covid-19 therapy) trial, conducted by the University of Oxford.

It’s testing whether existing medicines used for other conditions could also be useful in treating Covid-19.

About 2,100 patients received a 6mg daily dose of dexamethasone in the trial for 10 days.

Their progress was compared with a random sample of just over 4,300 patients who received no additional treatment.

Scientists hope dexamethasone could eventually be used as part of a suite of drugs which, together, could reduce deaths even further.

It is now recommended for adults, not including those who are pregnant or breastfeeding.

How widely available is the drug?

Dexamethasone is a low-cost drug which already exists and is in good supply.

The UK government says it had already stockpiled enough of the drug to treat 200,000 people, in anticipation of a good result from the trial.

The drug costs from £5.40 a day per patient and the treatment on Covid-19 patients last for up to 10 days.

It was first made in 1957 and became available for use in the UK in the early 1960s.

Because it’s been around for such a long time, the drug is out of patent.

That means lots of different companies can make the drug and it is widely available around the world.

The Department of Health and Social Care says the drug has also been added to the government’s parallel export list, which bans companies from buying medicines meant for UK patients and selling them on for a higher price in another country.

Dexamethasone tabletsImage copyright Justin TALLIS/AFP

 

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