COVID-19 FAQ #15: Is dexamethasone helpful against the COVID-19 infection?
Question: COVID-19 FAQ #15: Is dexamethasone helpful against the COVID-19 infection?
Continuing his COVID-19 FAQ series, Dr. Brian Durie discusses the RECOVERY trial which evaluates the benefit of the steroid dexamethasone when treating patients with COVID-19.
Dexamethasone is beneficial when treating patients for COVID-19 infections.
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This week’s “Ask Dr. Durie” comes from a patient who’s heard about a little bit of good news and wants to be sure he’s interpreting the news correctly. This patient heard that the drug dexamethasone, which is a steroid we use frequently in the treatment of multiple myeloma has been shown in a trial from the United Kingdom to benefit patients with the COVID-19 infection. And so, the questioner says, “Is this correct?”
And so, the first part of the answer is, yes. This was a large study where actually 2,400 individuals, and part of this trial, which is called the RECOVERY trial, conducted by the principle investigator at the University of Oxford. These patients were within a group of patients of over 11,000 patients. So, 2,400 got the dexamethasone.
Now the dexamethasone was given at a dosage of six milligrams for ten straight days. This was sufficient to really help with patients with severe lung disease, particularly, those requiring the use of a ventilator or high-level oxygen support. So, for them, use of the dexamethasone, this ten-day course, improved the survival significantly. So, this simple and cheap medicine really did make a difference.
And, this information fits in with previous information we’ve had that anti-IL-6 medication also helps to shut down, what we call, the cytokine storm that occurs in patients with very aggressive pneumonia findings, shutting that down with steroids and anti-IL-6, this indeed can be a helpful approach.
For a patient with myeloma, it’s also additionally reassuring because many patients are taking dexamethasone. And so, the concern has been “is my myeloma treatment putting me at risk for COVID-19?” And strangely, it seems that maybe the opposite is true, is that many myeloma treatments may even shut down this enhanced inflammatory reaction which is a part of the severe lung disease process. And so, dexamethasone is helpful, we also, know that one of the other medications recently approved, Selinexor®, is in trials, because it seems that it also can be helpful against the COVID-19.
And so, in this case, yes, the answer is correct, dexamethasone is helpful in COVID-19. And, it seems that patients don’t need to be too alarmed in continuing that as part of their myeloma therapy because it’s not really going to be harmful with regard to risks from COVID-19.
Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.