A month ago, a UK study showed that dexamethasone, a commonly used anti-inflammatory drug saved the lives of hospital patients who were seriously ill with COVID-19.
This trial, called the RECOVERY trial, which stands for Randomised Evaluation of COVID-19 therapy, was conducted by the University of Oxford.
According to the research scientists, dexamethasone showed the most benefit for those who were on ventilators where it prevented one in three deaths and for those on oxygen where it prevented one in five deaths.
The drug was only suitable for those already in hospital who were on oxygen therapy or on mechanical ventilation, essentially the most unwell patients.
It did not help those with milder symptoms.
Many treatment protocols worldwide have now been amended to include dexamethasone for those seriously affected by COVID-19.
Dexamethasone is a steroid––a type of medication that can reduce inflammation by imitating hormones, such as cortisol, which are naturally produced by the adrenal glands in the body.
These lab-made steroids, also called corticosteroids, are different from anabolic steroids which are known to be used often by people to increase their muscle mass.
Corticosteroids, such as dexamethasone and prednisolone work in a similar way as those hormones normally found in the body, by slowing or even stopping the immune system processes that trigger inflammation.
The discovery of cortisol and other adrenal hormones as well as the eventual chemical synthesis into its man-made counterparts began in the late 1940s and revolutionised the treatment of countless diseases.
One of the first conditions ever treated with a corticosteroid was rheumatoid arthritis.
Tadeusz Reichstein, Edward Kendall, and Philip Hench were a team of three scientists whose work on hormones of the adrenal glands culminated in the isolation of cortisol.
Their first patient with rheumatoid arthritis, who was injected with the then-experimental drug, was able to walk out of the hospital after the third treatment and go on a three-hour shopping spree despite debilitating pain and joint swelling before.
This breakthrough back in 1950 used a combination of good science and good luck and the trio managed to take their newly-discovered drug from the lab to the clinic straight to the Nobel Prize in Medicine within 2 years.
In time, corticosteroids have become a critical and life-saving component of treating many inflammatory diseases.
They are now commonplace in the management of asthma, lupus, multiple sclerosis, allergic reactions as well as skin conditions like eczema, and are available in every imaginable form, from pills and inhalers to nasal sprays, injections, creams, and ointments.
Despite their widespread use, the side effects of steroids still remain daunting and they need to be carefully regulated and monitored.
They are amongst the most widely-prescribed drugs in medicine with a global market worth of over $10 billion per year.
Could the humble steroid now be the key to beating COVID-19?
It seems plausible that a drug that works by reducing the body’s immune response may help.
We already know that coronavirus infection triggers an inflammatory response that encourages the body’s own immunity to over-react––the same reaction intended to fight the infection ends up attacking the body’s own cells.
But there is good reason to proceed with caution given the pace at which science has been moving during this pandemic, notwithstanding the fact that several other therapies that were initially heavily touted have since been found to be ineffective or indeed harmful.
Steroids can indeed be unsafe with serious side effects. Especially if given too soon, or to someone with only a mild infection, they can suppress the body’s own system from effectively fighting the virus, hence the recommendation for dexamethasone is currently for only the critically ill.
It does make sense to me that steroids would work for COVID-19.
After all, the virus may be the trigger, but what is killing people all over the world is the body’s immune response to the infection.
However, although randomised and appearing to consist of good quality data, the RECOVERY trial is still yet to be published which means the information presented to us needs to be carefully analysed and subjected to expert review.
Dexamethasone, while appearing promising, may not be the silver bullet hoped for and it is crucial to remember that the rules of science still apply.
After all, in the era of guidelines, protocols and algorithms, the heart of good medicine is using the available evidence, albeit with a personalised approach, to treat the sick with little or no harm.
In the end, as declared by one of the fathers of modern medicine, Sir William Osler (1849-1919), “the good physician treats the disease, but the great physician treats the patient who has the disease.”