US President Donald Trump’s medical team confirmed he has been prescribed dexamethasone, a steroid shown in studies to improve survival for patients hospitalised with critical COVID-19 symptoms.
The medication is cheap and widely-used but according to guidelines from the Infectious Disease Society of America, it should not be given in mild cases since it can limit the body’s own ability to combat the virus.
Here’s what we know about the drug and its effectiveness in treating COVID-19.
What is dexamethasone?
Dexamethasone has been used since the late 1950s, so doctors are familiar with it.
It’s also inexpensive, with a packet of 30 tablets costing around $22 (for general patients) under Australia’s Pharmaceutical Benefits Scheme.
So if it does work for COVID-19, it would be easy to add to current treatments.
Dexamethasone belongs to a class of drugs known as corticosteroids and is used to treat a range of conditions related to inflammation.
These include severe allergies, some types of nausea and vomiting, arthritis, swelling of the brain and spinal cord, severe asthma and for breathing difficulties in newborn babies.
And it’s dexamethasone’s application to those latter two respiratory conditions that prompted doctors to think it may also help patients severely affected by COVID-19.
What is dexamethasone usually prescribed for?
Described as cheap, old and boring, the drug is used to reduce inflammation in diseases such as arthritis.
Trial results released in June showed dexamethasone reduced death rates by about a third among the most severely ill COVID-19 patients admitted to hospital.
Researchers who led the trials said the preliminary results suggested the drug should immediately become standard care in patients with severe cases of the pandemic disease.
Dr Brian Garibaldi said Mr Trump was given the steroid in response to “transient low oxygen levels”.
The President received his first dose on Saturday and his doctors plan is to continue the treatment for now.
Dr Garibaldi said the President was not showing any side effects of the drugs “that we can tell”.
How might dexamethasone work for COVID-19?
When a patient has severe COVID-19, their immune system ramps up to catch and control the virus in the lungs.
In doing this, their body produces more infection-fighting white blood cells.
This results in inflammation and pressure on their lungs, making it very difficult for them to breath.
It’s therefore likely dexamethasone reduces this inflammation and so reduces pressure on the lungs.
It shouldn’t be used in all coronavirus cases however
Among patients with COVID-19 who did not require respiratory support, there was no benefit from treatment with dexamethasone.
Dexamethasone also suppresses the immune system when it reduces inflammation, so it’s not usually recommended for people who are sick, or could be sick, from other infections.
Doctors need to make sure patients have no other infections before they are prescribed the drug.
The drug is only useful for patients with difficulty breathing and needing some assistance either through ventilation in a hospital or from oxygen therapy.
There appears to be no benefit for patients who don’t need help breathing.
So we shouldn’t be giving it to everyone who tests positive to the virus.
