Is Dexamethasone The Miracle COVID-19 Drug That Everyone Was Hoping For?

Editor's Note: This story has been updated to include the Malaysian Ministry of Health's statement regarding the drug.



Dexamethasone, a widely available and relatively cheap steroid, was one of several drugs tested by the Randomised Evaluation of COVID-19 Therapy (RECOVERY) team led by pharmaceutical researchers at the University of Oxford. 

After randomly testing over 6,000 COVID-19 patients from the UK since March, the researchers released preliminary findings that indicated the drug may be able to lower the risk of death by one-third in patients on ventilators and by one-fifth in those who were only receiving oxygen. 

According to the RECOVERY report, the drug did not benefit patients who were not on respiratory support. 

Dexamethasone is an anti-inflammatory steroid, called a corticosteroid, which can help alleviate swelling, redness, itching, and allergic reactions, according to Mayo Clinic. 

It is a generic steroid that has been available since the 1960s to treat various diseases including asthma, rheumatism, multiple sclerosis, and allergies. Cancer patients are often given the drug to relieve nausea triggered by chemotherapy, according to the official dexamethasone website. 

Medical experts like Mount Sinai-National Jewish Health Respiratory Institute chief executive officer Dr Charles Powell, found that it was inflammation and immune responses to the coronavirus, rather than the virus itself, that led to lung disease in COVID-19 patients.

He told Rolling Stone, "Early cases in Wuhan indicated a potential role for steroid in treating patients with moderate to severe lung involvement."

The dosage costs approximately USD6.79 (RM29.05) per day. A full round of treatment is said to be up to 10 days.

Contributors to the RECOVERY study commented on the results of the clinical trial.

"COVID-19 is a global disease - it is fantastic that the first treatment demonstrated to reduce mortality is one that is inherently available and affordable worldwide," noted University of Oxford's professor of medicine and epidemiology Martin Landray.

The UK Government's chief scientific adviser Sir Patrick Vallance added, "This is a groundbreaking development in our fight against the disease… It shows the importance of doing high quality clinical trials and basing decisions on the results of those trials."

The World Health Organization has also welcomed dexamethasone to treat COVID-19 patients who require respiratory support.

During a press conference, UK Prime Minister Boris Johnson hailed dexamethasone as their biggest breakthrough yet in the fight against the novel coronavirus.

When asked by a reporter why dexamethasone had been added to a list of drugs that could not be exported from the UK, Boris replied saying that he would look into it, reported the Huffington Post.

This refers to a government list of medicines that cannot be exported from the UK nor hoarded. Dexamethasone tablets were added to the list on 24 April, and its oral solution was banned just yesterday.

The ban may affect countries like Malaysia who rely on other nations to procure their medicines, as shown by the sale of hydroxychloroquine tablets to Malaysia by India.

Some of the already known side effects of dexamethasone include risk of heart damage (if the patient recently had a heart attack), worsening of infections, and eye issues such as cataract or glaucoma. 

Numerous medical professionals are encouraging the public to remain cautious of the results of the clinical trial, at least until the release of published data or a peer-reviewed article that evaluates the study in-depth. 

Corticosteroids like dexamethasone were used in 2003 and 2004 to treat critically ill severe acute respiratory syndrome (SARS) patients.

In an interview with Rolling Stone, associate professor in the College of Medicine and Life Sciences at the University of Toledo Dr Jennifer Hanrahan said, "For some of these patients who are critically ill - who are on ventilators - we are seeing some secondary bacterial infections when they're in hospital, so giving corticosteroids also potentially increases the risk of other infections."

Deputy physician-in-chief at Northwell Health in New York Dr Thomas McGinn told Reuters that steroids can suppress immune systems that are responsible for fighting against foreign substances in the body, like viruses.

Yale School of Medicine chief of allergy and immunology Dr Christina Price told Rolling Stone, "When you put [diabetic patients] on steroids, their glucose increases significantly, and oftentimes they have to go on insulin or glucose control." 

Additionally, patients previously without a diabetes diagnosis could later develop hyperglycaemia - high blood sugar levels.

Malaysian health officials previously announced that they were using hydroxychloroquine tablets to treat patients with mild COVID-19 symptoms. 

There are mixed opinions on the impact of the anti-arthritis drug on improving COVID-19 symptoms. A since retracted study in The Lancet medical journal suggested that it showed no benefit for COVID-19 patients, while a small French study indicated that some patients showed signs of improvement. 

Even then, dexamethasone cannot be procured over the counter, and health officials warn that the drug should not be used for prevention or mild cases of COVID-19.

A tweet by the Malaysian Ministry of Health said, "Dexamethasone does not help COVID-19 patients with mild symptoms or those who are not on ventilators."

They added that the drug can only be prescribed by medical professionals, further reminding the public that dexamethasone is still in preliminary testing.