The dexamethasone, the first drug to prove that it could save patients from Covid-19, should probably not be administered to patients who are in the initial stages of the disease and do not need respiratory assistance, according to the full results d ‘a clinical trial published Friday.
It is the only drug, with the antiviral remdesivir, to be part to date of the arsenal with proven efficacy against the coronavirus, thanks to large clinical trials which have compared their effects in a rigorous manner with others. treatments (remdesivir reduces length of hospital stay but not mortality), while other drugs, such as hydroxychloroquine, have failed to show an effect.
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In the process, these drugs have been adopted in international therapeutic recommendations, and their production is increasing. The low cost of dexamethasone, an old drug, should facilitate its use worldwide.
Promising, confirmed results
The British trial Recovery announced in a statement 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 oxygen but were not on an artificial respirator.
The full results of this long-awaited trial, in which 15% of British patients hospitalized for the coronavirus participated, were published 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.
The 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 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 suggest a “possible harmful effect“.
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“This is perfectly compatible with the fact that at the beginning of the infection, we need the immune system to attack the virus.“Anthony Fauci, director of the American Institute of Infectious Diseases, told AFP in June.
The beneficial effects of this family of drugs, conclude the authors of the article, “likely depend on selecting the right dose, at the right time, in the right patient“.
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