Is Dexamethasone Use For COVID-19 Beneficial?

Dexamethasone significantly improved outcomes in patients requiring supplementary oxygen and in ventilated patients with COVID-19 in the RECOVERY trial. It is now routinely used in these patients. However, dysglycaemia is commonly associated with steroid use and is an established risk factor for poorer outcomes in COVID-19. It can increase the risk of other infections and cause metabolic imbalance.  

What is Dysglycaemia? 

Dysglycaemia is defined as either Diabetes mellitus (DM) or elevated blood glucose that does not reach the threshold of DM (also called prediabetes).

Once hyperglycaemia occurs, people with any type of DM are at high risk for multiple comorbidities affecting most organs of the body, in particular cardiovascular disease (CVD) that affect the heart, brain, peripheral vessels, and also microcirculation in many organs. CVD associated with DM is common; the majority of people with DM have CVD. DM magnifies the risk of CVD morbidity and mortality.

New Study Results 

Researchers studied whether these people experience severe complications from the side effects of steroid treatment and found that those who received treatment with dexamethasone had a 56% reduced risk of death or ICU admission from COVID-19.

The results were released at the November 2021 Society for Endocrinology meeting after observing a large group of people with COVID-19 receiving treatment with dexamethasone. 

To understand dexamethasone’s effects, researchers looked at the number of ICU admissions, reduced mortality, and steroid-related complications in 2,261 patients admitted to the Imperial College Healthcare National Health Service (NHS) Trust hospitals.

The team divided data from individuals hospitalized with COVID-19 into two groups: wave one and wave two. Wave one consisted of 889 people admitted to the hospital between March and April 2020, when doctors did not routinely prescribe dexamethasone. Wave two comprised 1,372 individuals admitted between November 2020 and January 2021 who took prescription dexamethasone routinely.

They found that patients were less likely to be admitted to the ICU in wave two (18.8%) compared to 27.6% in wave one. There was also a mortality reduction in wave two, with a 31.8% reduced risk of death. 

The researchers came to the conclusion that dexamethasone treatment reduced the risk of death and ICU admission by 56% and that it was independently associated with a decreased risk of both factors to the same extent in people with and without diabetes. 

Source:

Mary McGorray, M.D. (2021, Nov 16). Dexamethasone treatment for COVID-19: Benefits outweigh risks. Medical News Today. Retrieved from: 

https://www.medicalnewstoday.com/articles/dexamethasone-treatment-for-covid-19-benefits-outweigh-risks

Divani Narendranathan, et al. Audit of Clinical Outcomes with Dexamethasone in Patients Hospitalises with COVID-19 Metabolism, Obesity and Diabetes. 2021. Endocrine Abstracts (2021) 77 OP4.4 | DOI: 10.1530/endoabs.77.OP4.4

https://oxfordmedicine.com/view/10.1093/med/9780198784906.001.0001/med-9780198784906-chapter-214

Image from: 

https://www.tctmd.com/news/published-data-detail-how-and-when-dexamethasone-might-help-covid-19