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Use of the anti-inflammatory corticosteroid dexamethasone to treat adult patients with severe Covid-19 has increased the number of days they have been ventilator-free.
The conclusion is from an investigation carried out by Coalizão Covid-19 Brasil, led by the Albert Einstein, HCor, Sírio-Libanês hospitals. Moinhos de Vento, Oswaldo Cruz and Beneficência Portuguesa, for the Brazilian Institute of Clinical Research (BCRI) and the Brazilian Network for Research in Intensive Care (BRICNet).
In July, the same group published research showing that hydroxychloroquine is not effective in treating patients with mild or moderate Covid-19 symptoms.
The conclusion of the current investigation was that the number of days off the ventilator was greater in the dexamethasone-treated patients (mean 6.6 days) than in the control group (mean 4 days).
“These are the steps we are taking,” says Dr. Alexandre Biasi, from HCor. “The disease is serious and there are patients who remain intubated for many days. With corticosteroids, there is an additional gain, a benefit,” he says.
The study on dexamethasone was conducted with 299 patients with severe acute respiratory syndrome undergoing mechanical ventilation (artificial respiration) in 41 Brazilian Intensive Care Units (ICU). They were around 61 years old (60% were men) and were admitted between April 17 and June 23, with clinical follow-up ending on July 21.
The patients were divided, by batches, into two groups: in one (151 patients), they were treated with dexamethasone and standard clinical support; in another, the control group (148 people), with only standard clinical support.
Dexamethasone was used intravenously at a dose of 20 mg for 5 days and 10 mg for 5 days. The evaluation of the effect of dexamethasone treatment considered the number of days the patient remained off the ventilator for up to 28 days as the main outcome.
Earlier removal of the ventilator, according to the researchers, may be associated with a lower risk of complications arising from the ICU stay, earlier discharge from the intensive care unit with the release of beds, and savings in human resources and economical.
The study did not show an increased risk of dexamethasone treatment in relation to new infections, glucose changes, and other serious adverse events. Mortality at 28 days was 58% when considering the total number of patients included; there was no distinction between the differences in this rate between the two groups of patients.
The Coalizão Covid-19 Brazil group highlights that the results are not applicable to other cases, such as outpatients with milder and initial forms of Covid-19 or who are not on artificial respiration.
The results of the group’s research on dexamethasone were published in the scientific journal “Journal of the American Medical Association” (JAMA).
