A study confirms that dexamethasone should not be given to patients at the start of their disease, but only when the disease progresses.
Dexamethasone is a corticosteroid that has an anti-inflammatory and immunosuppressive effect (archives).
KEYSTONE/EPA/JORGE TORRES
Dexamethasone should not be given to patients who are in the initial stages of Covid-19 and do not require respiratory assistance, according to one study. It is the only drug with the antiviral remdesivir to have proven efficacy against the coronavirus.
The British trial Recovery announced 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 received l oxygen but without being on an artificial respirator.
The full results of this trial, eagerly awaited and in which 15% of British patients hospitalized for the coronavirus, were published on Friday in the medical journal 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) died 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 non-invasively (23.3% versus 26.2%). The results are best in those who have had symptoms for seven days or more.
Right dose at the right time
The data confirm that dexamethasone should not be given to patients at the onset of their disease, which seems logical, since steroids are intended to decrease the immune response. It is only when the disease progresses that a nervous system runaway appears in the patient and causes serious inflammation in various organs of the body, which are often the cause of death.
In the patients without respiratory assistance, the number of deaths was greater in the dexamethasone group than in the other, a statistically insignificant difference, but the authors cite a “possible harmful effect”.
“It is perfectly compatible with the fact that at the beginning of the infection, one needs the immune system to attack the virus,” explained Anthony Fauci, director of the American institute of infectious diseases, in June at 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”.
(ATS / NXP)
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