The benefits of dexamethasone therapy for COVID-19 exceed the risks

dexamethasone
Recent research looks at the dangers of using dexamethasone as a COVID-19 therapy.
  • Individuals with severe COVID-19 often undergo treatment with a steroid drug called dexamethasone.
  • Researchers looked at whether these individuals suffer from serious consequences as a result of their steroid therapy.
  • COVID-19 patients who got dexamethasone therapy showed a 56 percent lower risk of mortality or ICU admission.
  • Dexamethasone does not increase mortality or ICU admission in people with severe COVID-19., according to metabolic specialists.

When the worldwide SARS-CoV-2 epidemic broke out, physicians and researchers hurried to develop effective treatments for COVID-19’s life-threatening consequences. Early clinical data suggests that giving strong steroids to people with COVID-19 who need oxygen or mechanical breathing improves their outcomes.

Steroids, on the other hand, have negative side effects, such as increased blood glucose levels. Short- and long-term consequences, such as an increased risk of infection or metabolic imbalance, can occur in people with and without a history of diabetes.

After watching a large sample of people with COVID-19 undergoing therapy with dexamethasone, a steroid used to treat patients with lung inflammation, researchers presented their findings at the Society for Endocrinology meeting in November 2021.

Standard of care

According to Dr. Victoria Salem, a senior investigator, “Dexamethasone is now the standard of treatment in patients hospitalized with [COVID-19] requiring oxygen based on the RECOVERY study,”. We looked at almost 2,000 patients in our London hospital who had COVID-19 and ran a multivariate analysis of mortality risk variables.

“Diabetes has long been recognized as a risk factor for severe COVID. High blood sugar levels are also linked to a bad outlook. We were concerned that dexamethasone might be a double-edged sword for diabetic patients because it raises blood sugar levels, but it turned out to be just as effective.

Methods

Researchers looked examined the number of ICU admissions, decreased mortality, and steroid-related complications in 2,261 patients admitted to Imperial College Healthcare National Health Service (NHS) Trust hospitals to better understand dexamethasone’s effects.

The researchers separated the data from COVID-19 patients into two waves: wave one and wave two. Wave one included 889 people who were hospitalized to the hospital during March and April 2020, when dexamethasone was not frequently prescribed. Wave two included 1,372 people who were hospitalized between November 2020 and January 2021 and were prescribed dexamethasone on a regular basis.

Real-world results

People were less likely to be admitted to the ICU in wave two (18.8%), compared to 27.6% in wave one, according to the research. In wave two, there was also a decrease in mortality, with a 31.8 percent lower chance of death. High blood pressure, increased frailty, lower renal function, and being male were all additional risk factors for ICU admission and reduced death.

Dr. Salem explained to MNT:

“In wave two, [d]examethasone was used in 68% of patients in our hospital with a diagnosis of [COVID-19], 35% of whom had diabetes.

[O]f the patients treated with dexamethasone for COVID, 19% developed hyperglycemia (high blood sugars) that required additional treatment. [A]nd, of this group, 12% were new diagnoses of diabetes — the [r]emainder of patients experienced worsening preexisting diabetes.”

[D]r. Salem clarified that this “real world” value is far greater than the RECOVERY study’s original result.

“So, 21 people out of 935 (2%) given dexamethasone for [COVID-19] developed steroid-induced diabetes.”

Conclusions

Treatment with dexamethasone cut the chance of mortality or ICU admission in trial participants by 56%. To Medical News Today, Dr. Salem explained:

“In people with [d]iabetes and those without diabetes, dexamethasone was independently related with a lower risk of death/ICU admission to the same amount.”

“Dexamethasone-induced diabetes often resolves when the treatment is stopped. It adds an extra burden in terms of management and follow-up but [is] worth it given the overall benefits in terms of recovering from [COVID-19]. Given the current obesity epidemic, many of the patients may already have had undiagnosed type 2 diabetes, and this was a wake-up call.”

Dexamethasone therapy lowered the risk of mortality and ICU admission, according to the findings. Furthermore, diabetic patients are more likely to have steroid-induced glucose control issues, although death rates do not rise as a result.