What is the use of Dexamethasone (corticosteroid)?

From the Guidelines

Dexamethasone should be used at a dose of 6 mg daily for up to 10 days in hospitalized patients with COVID-19 who require oxygen, as it has been shown to reduce mortality in these patients. This recommendation is based on the most recent and highest quality evidence from the UK RECOVERY trial, which demonstrated a statistically significant reduction in mortality with corticosteroid treatment in patients receiving invasive mechanical ventilation and those requiring supplementary oxygen 1. The trial found that dexamethasone reduced 28-day mortality by 35% amongst patients on invasive mechanical ventilation and by 20% amongst patients on supplemental oxygen therapy 2.

Key Points

• Dexamethasone is a potent synthetic corticosteroid medication with anti-inflammatory and immunosuppressive properties.
• It is commonly prescribed at doses ranging from 0.5 mg to 10 mg daily, depending on the condition being treated.
• In the context of COVID-19, dexamethasone is typically given as 6 mg once daily for up to 10 days to hospitalized patients requiring oxygen.
• The use of dexamethasone in COVID-19 patients has been shown to reduce mortality, particularly in those requiring invasive mechanical ventilation or supplemental oxygen therapy 1, 2.
• Common side effects of dexamethasone include increased blood sugar, mood changes, insomnia, increased appetite, and fluid retention.
• Long-term use of dexamethasone can lead to more serious effects like osteoporosis, adrenal suppression, increased infection risk, and hypertension.

Clinical Considerations

• Patients should be closely monitored for signs of adrenal suppression and other potential side effects when taking dexamethasone.
• The decision to use dexamethasone in COVID-19 patients should be made on a case-by-case basis, taking into account the individual patient's condition and medical history.
• Dexamethasone should not be stopped abruptly, as this can lead to adrenal crisis, a potentially life-threatening condition.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Dexamethasone sodium phosphate injection has a rapid onset but short duration of action when compared with less soluble preparations. Because of this, it is suitable for the treatment of acute disorders responsive to adrenocortical steroid therapy Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs, including dexamethasone, are primarily used for their potent anti-inflammatory effects in disorders of many organ systems. This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted. If the patient is receiving steroids already, dosage may have to be increased.

The question about Dexamethasone is not specific, and the provided text does not directly answer a specific question about the drug. However, based on the information provided, key points about dexamethasone include:

• It has a rapid onset but short duration of action.
• It is used for the treatment of acute disorders responsive to adrenocortical steroid therapy.
• It is primarily used for its potent anti-inflammatory effects in disorders of many organ systems.
• Hormone therapy may need to be reinstituted in situations of stress after discontinuation of dexamethasone therapy 3, 4.

From the Research

Dexamethasone Overview

• Dexamethasone is a corticosteroid that has been used to modulate the immune response in a wide range of diseases for over 70 years 5.
• It has anti-inflammatory, analgesic, and anti-allergic characteristics, including the ability to inhibit the immune system 5, 6.

Role in COVID-19

• The use of dexamethasone has been shown to increase the chance of survival and relief in COVID-19 patients by combating the viral strong inflammatory impacts 5, 7.
• Dexamethasone treatment was associated with a short-term reduction in T cell and antibody responses in severe COVID-19, but this difference evened out 6 months after infection 8.
• The RECOVERY trial, a massive, multidisciplinary, randomized, and open-label trial, is mainly accountable for recommendations over the usage of corticosteroids in COVID-19 patients 5, 7.

Mechanism of Action

• Dexamethasone may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death in COVID-19 patients 7, 9.
• The virus may cause glucocorticoid insensitivity in infected cells, which interferes with undesired glucocorticoid effects and facilitates viral replication, but does not affect desired anti-inflammatory properties in non-infected organs/tissues 9.

Clinical Outcomes

• The use of dexamethasone resulted in lower 28-day mortality among COVID-19 patients who were receiving either invasive mechanical ventilation or oxygen alone at randomization, but not among those receiving no respiratory support 7.
• Dexamethasone treatment has been shown to reduce the mortality rate among severe COVID-19 cases 6.