The race to find an effective treatment method and ultimately a cure for Covid-19 has been ongoing for the past six months. With the World Health Organization citing an increase of 6 million cases in the past two months, any significant finding which will aid in this ongoing.
Recently, the steroid dexamethasone has been touted as a breakthrough in the treatment of Covid-19. In March, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) clinical trial was established with over 11 500 patients enrolled from over 175 NHS hospitals in the UK.
The study found dexamethasone reduced deaths by one third in patients who needed ventilation and by one fifth in other patients receiving oxygen only – with no benefit among patients who did not require respiratory support, the study published.
Citing the fanatic response the public had to hydroxychloroquine as a preventative drug even though “Lancet [Laboratories] found no benefit in hydroxychloroquine prophylaxis for Covid-19 contacts”, says Professor Veronica Ueckermann, head of the Covid-19 response team and adjunct professor: at the department: internal medicine University of Pretoria and Steve Biko Academic Hospital. The South African Health Products Regulatory Authority (SAHPRA) has warned against using hydroxychloroquine .
Speaking to DRUM, SAHPRA spokesperson Yuven Gounden says the body strongly advises against the use of the steroid to prevent disease. However, “Dexamethasone is a highly potent anti-inflammatory steroid reserved for severe inflammatory conditions where tissue damage is a serious complication,” he says.
The drug comes with revelations of post-Covid-19 care being required for patients who would have suffered a severe course of the disease. Experts in in the UK have voiced concerns over a significant proportion of patients who could be left with lung scarring, known as pulmonary fibrosis. The condition is irreversible and symptoms can include severe shortness of breath, coughing and fatigue, the BBC reported.
Dexamethasone is an improvement as it pushes past common practice which suggests caution when using steroids in patients with viral pneumonia and in acute respiratory distress syndrome (ARDS) as steroids usually suppress the immune system even further and lead to worse infection.
“Severe Covid-19 presents with an overactive immune response to the viral infection. This leads to damage to the lungs, which then need assisted breathing through ventilation and oxygenation,” says Gounden, citing that the immune response could sometimes cause more harm than good.
Prof Ueckermann shares similar sentiments, saying, “One of the key features of severe Covid-19 pneumonia is the ‘cytokine storm’ which is a state of hyperinflammation. Sometimes such a severe immune response can actually cause equal or more damage to organ systems than the virus itself. The rationale for steroid use would therefore be to limit the damage done by a hyper-inflammatory state. The preliminary statements brought forward from the RECOVERY trial group is that they are seeing a survival benefit in patients with Covid-19 pneumonia, who required oxygen, when dexamethasone was used.”
Part of the response to the viral pandemic has been the WHO global clinical trials that South Africa is part of. Pioneering the trials in SA are Dr Jeremy Nel and Professor Helen Rees. The tria,l which have been pending for some time, is seeing progress, Dr Nel says. “Drugs are expected to arrive in South Africa this week. Once they clear customs and we can send them to the trial sites, we should be able to start the trial in those sites that have all their permissions in place. We’re very keen to start.”
On the use of dexamethasone in the trials, he says patients are likely to receive the drug in conjunction to the Solidarity Trial drugs. Gounden noted that dexamethasone is already in use in SA, but “for severe inflammatory conditions and where tissue damage is a serious complication”.
Dr Nel says, “Solidarity isn’t looking at testing dexamethasone as part of the trial, but Solidarity is designed to work around whatever the background standard of care is. Therefore, it is perfectly fine for all the patients who are enrolled in Solidarity and who require oxygen to get dexamethasone from their doctors in addition to the drugs that Solidarity is testing. We anticipate this is exactly what will occur. All patients who are part of Solidarity are certainly eligible for dexamethasone too.”