June 30, 2020
By Douglas L. Jennings, PharmD, FACC, FAHA, FCCP, FHFSA, BCPS
The population of the COVID-19 drug therapy graveyard is slowly growing. Azithromycin, a macrolide antibiotic initially endorsed based on very limited evidence, was one of the first members. More recently, the highly touted antimalarial agent hydroxychloroquine joined after a series of studies showing neutral effect on COVID outcomes, along with several high-profile retractions in reputable journals like The Lancet. On the heels of these failures and blunders, the medical community has become more rightly skeptical of any new therapy which purports benefit. Enter…dexamethasone.
Dexamethasone is an inexpensive, widely available corticosteroid. This agent is used for a variety of medical conditions and has recorded many decades as a fairly safe drug therapy. On June 16th, researchers at Oxford University leaked preliminary findings from a study of several thousand patients infected with COVID-19. The press release reported that patients with severe disease—which included those on supplemental oxygen or requiring mechanical ventilation—had a significantly lower rate of death when prescribed dexamethasone. No benefit was noted in patients who did not require oxygen.
These findings, if confirmed when the full study results are published, represent a potential watershed moment for the therapy of COVID-19. Until now the only other agent with any demonstrated benefit is Remdesivir, which only shortens the disease course without affecting mortality rates. Dexamethasone may represent a potentially lifesaving treatment for those with the most severe manifestations of SARS-CoV-2 infection.
Dexamethasone may improve outcomes in COVID-19 infection by curtailing the untoward effects cytokine-release syndrome or “cytokine storm,” which can affect patients with severe disease and likely contributes to the high mortality rate with this viral infection. While this agent is relatively safe, it does suppress the immune system, which could also impair the body’s natural defense against SARS-CoV-2. Therefore if the benefits are confirmed with publication of the full study, dexamethasone should only be recommended in those who fit the study criteria, namely hospitalized patients with significant hypoxemia.
The leaked “sneak peak” of this study has demonstrated rightful optimism in the United Kingdom, where physicians are already allowed to prescribe it for COVID-19 as of this week. Many experts in the United States are more cautious, instead urging patience until the full study has been published.
Dr Jennings is currently an Associate Professor of Pharmacy at Long Island University and the clinical pharmacist for the Heart Transplant and LVAD teams at NewYork- Presbyterian Hospital Columbia University Irving Medical Center. He is an active researcher in his field, and he has published over 120 peer-reviewed abstracts and manuscripts, primarily focusing on the pharmacotherapy of patients under mechanical circulatory support. As a recognized expert in this area, he has been invited to speak at numerous national and international venues, including meetings in France, Saudia Arabia, India. Finally, Dr. Jennings has been active in professional organizations throughout his career. He is a fellow of the American College of Clinical Pharmacy, the American College of Cardiology, the Heart Failure Society of America, and the American Heart Association.