Dexamethasone, the first drug to be shown to save Covid-19 patients, probably should not be given to patients who are in the initial stages of the disease and do not need respiratory assistance, according to the results full reports from a clinical trial published Friday.
It is the only drug, along with the antiviral remdesivir, to date in the arsenal of proven efficacy against the coronavirus, thanks to large clinical trials which have compared their effects rigorously to others. treatments (remdesivir reduces the length of hospital stay but not mortality), while other drugs, such as hydroxychloroquine, have failed to show any effect.
In the process, these drugs were adopted in recommendations international therapies, and their production is increasing. The low cost of dexamethasone, an older drug, should make it easier to use around the world.
The British trial Recovery announced in a press release on June 16 that dexamethasone, a corticosteroid (anti-inflammatory), reduced mortality by a third compared to standard treatments in intubated patients, and by a fifth in patients who were receiving oxygen but not on life support.
The full results of this eagerly awaited trial in which 15% of UK patients hospitalized with coronavirus participated were published in the New England Journal of Medicine; they confirm and detail the results announced in June.
29.3% of intubated patients who took dexamethasone (6 mg per day) are dead within 28 days, compared to 41.4% for intubated patients who received standard treatment, at comparable ages. The reduction is less for those who received oxygen so non invasive (23.3% vs. 26.2%).
Results are best in those who have had symptoms for seven days or more.
The data confirm that dexamethasone should not be given to patients at the onset of their illness, which seems logical, since steroids are intended to decrease the immune response. It is only when the disease progresses that a runaway immune system appears in the patient and causes severe inflammation in various organs of the body. corps, which are often the cause of dead.
In patients without respiratory support, the number of dead was bigger in the group dexamethasone than in the other, a statistically insignificant difference, but the authors suggest a “possible harmful effect”.
“This is perfectly compatible with the fact that at the start of the infection, we need the immune system to attack the virus », Explained Anthony Fauci, director from the American Institute of Infectious Diseases, in June to AFP.
The beneficial effects of this family of drugs, conclude the authors of the article, “probably depend on the selection of the right dose, at the right time, in the right patient”.
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