A steroid that has been found to help critically ill coronavirus patients doesn’t help in milder cases, a new study suggests.
Last week, British researchers released preliminary findings showing that dexamethasone reduced mortality rates in patients on ventilators and patients on supplemental oxygen without ventilation.
But in the full report released this week, the results showed that patients who did not receive any form of oxygen support fared better if they received usual care rather than the drug.
Since the initial findings were first announced, the demand for dexamethasone has increased by 610 percent, in some cases even exceeding the supply of the medication.
Last week, British researchers revealed that dexamethasone, a steroid, reduced mortality by a fifth in those who received supplemental oxygen (left) and by a third in patients who received mechanical ventilation (right)
In patients who did not receive respiratory support, the study found that a slightly higher percentage of those who received the drug died than those who did not (photo)
Published on the pre-print site for the study medRxiv.org, the team looked at more than 6,400 patients enrolled in the RECOVERY study in the UK.
The trial, conducted by the University of Oxford, aims to identify the treatment of those who are confirmed or suspected to have COVID-19, the disease caused by the virus.
More than 2,100 patients received six milligrams of dexamethasone daily for 10 days, while more than 4,300 received usual care.
Dexamethasone was found to benefit most from patients who were seriously ill.
The drug reduced deaths by a third of patients who received invasive mechanical ventilation and by a fifth of patients who received supplemental oxygen.
However, it did not reduce the death rate in people who did not receive respiratory support.
Steroids reduce the activity of the immune system, which is beneficial in later stages of the virus, but harmful in milder and early stages. Pictured: A figure shows how dexamethasone was better for critically ill patients, as well as how usual care was better for mild cases
Since the preliminary findings were released last week, demand for the drug (photo) has increased by more than 600% in the US.
In fact, patients who received dexamethasone died slightly faster than those who did not – 17 percent to 13.2 percent – but not enough to be significant.
Senior author Dr. Martin J. Landray, a professor of medicine and epidemiology at Oxford University, said The New York Times that this is probably due to the effect of the medication on the immune system.
Steroids work by reducing inflammation and decreasing the activity of the immune system, which can actually harm patients in the early stages of the virus.
“In the early stages of the disease, the immune system is your friend. It fights the virus and dampening it is not a good idea, “Landray told the newspaper.
In the later stages, the immune system becomes the enemy. This is when so-called cytokine storms, which occur when the body not only attacks the virus, but also turns up its own tissues and cells.
In the later stages, the immune system is no longer your friend. It is responsible for lung failure and moisturizing with steroids helps the situation and improves survival, ”Landray said.
The news that dexamethasone is likely to only help critically ill patients has not stopped American doctors from getting their hands on it.
Demand in the U.S. hospitals for the steroid has more than sixfold, according to Vizient Inc, which buys drugs for half of U.S. hospitals and other health care systems.
The purchasing group said more than 2.8 million orders for the drug were made last week, compared to 397,500 last week.
On the day the preliminary findings were released June 16, demand rose 167 percent, Vizient said.
However, the drug’s fill rate dropped from 97% to 54%, meaning pharmacies are struggling to keep up with demand. Pictured: A sensitive team converts a patient with COVID-19 to ICU at Stamford Hospital in Stamford, Connecticut, April 24
Manufacturers were only able to fulfill about half of those orders. The drug’s fill rate dropped from 97 percent to 54 percent.
This means that pharmacies are struggling to keep up with demand. Fortunately, many hospitals have been able to treat patients from their own inventory.
What we hear from our members is that they can treat the patients who need dexamethasone – they treat them and they have [the] product, ”said Steven Lucio, vice president of pharmacy solutions at Vizient Reuters.
“The concern is, can the market continue to do this?”
The U.S. Food and Drug Administration (FDA) has not yet approved the emergency use of dexamethasone in coronavirus patients.
In addition, the FDA says the injectable form of the drug has been deficient since February 2019.