Dexamethasone – A Panacea?

From humble steroid to heralded superhero, Dexamethasone is a basic anti-inflammatory recently catapulted into the headlines. This cheap - £5.40 per course of treatment – and cheering – it relieves pain – drug has prompted the United Kingdom’s Chief Medical Officer to say “it should be used on patients with immediate effect” to save lives during this coronavirus pandemic. 

With the easing of lockdown, we are living life ‘almost as we know it’, awaiting the imminent arrival of a vaccine. Until then, COVID-19 can pose a deadly threat, while the potential of a winter resurgence looms forebodingly on the horizon.  And in our brave new world of increasingly sophisticated treatments and cutting-edge medication, one worthy and effective combatant of this invisible disease is a simple standard therapy for anti-inflammatory disorders.

Evolved in the middle of the last century, steroids transcend the label ‘drug’ and are seen instead by scientists as ‘active biological agents that typically have four carbon rings’. Such substances act as signalmen, sending important instructions around the body. Emulating the adrenal gland, they mimic the anti-inflammatory hormones produced by the body, quelling pain and suppressing allergies. Cortisone, the first corticosteroid drug to be developed, liberated an arthritic patient from her bed and onto her feet for the first time after just three days of treatment. Several pioneering discoveries later, Dexamethasone was created, but known as Decadron. Commonly used to ease everything from arthritis and psoriasis to brain swelling, and breathing difficulties in newborns, it was seized upon immediately as a wonderdrug. Meanwhile steroid became synonymous with bodybuilders and sporting scandals plunging their reputation into the doldrums.

But in a wondrous reversal of reputation, Dexamethasone has came into its own once more, its anti-inflammatory properties proving an important antidote to the fatally overactive immune system precipitated by COVID-19. In battling coronavirus, our bodies can overstimulate our immune system which in turn triggers inflammation – a cytokine storm - and, ironically, that which was meant to protect us can kill us. At this critical stage, according to Knowable Magazine: “Immune cells have flooded into the lungs and attacked them, when they should be protecting them. Blood vessels leak, and the blood itself clots. Blood pressure plummets and organs start to fail”.

At this critical stage, mechanical ventilation compounds the damage, destroying cells in the lungs and prompting swelling as the exchange surface thickens and becomes useless. With lung tissue destroyed, the scarring precludes the exchange of oxygen, and even if the patient survives this ordeal, many will return home with chronic lung disease – COPD. Dexamethasone by contrast can ensure this lung function remains intact. So far the figures are:

For patients on ventilators, it cut the risk of death from 25% to 20%.

For patients needing oxygen, it cut the risk of death from 25% to 20%.

 

Dexamethasone – A Panacea?
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