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SINGAPORE: The steroid known as dexamethasone is recommended for patients with “severe” COVID-19 infection who require supplemental oxygen or mechanical ventilation, according to interim treatment guidelines updated by the National Center for Infectious Diseases (NCID) in August.
The guidelines provide up-to-date evidence-based recommendations on the treatment of COVID-19 patients in Singapore.
The NCID clinical director had said in response to CNA inquiries in June that steroids were not routinely recommended for COVID-19 patients in Singapore at the time due to possible harmful effects.
NCID INTERIM TREATMENT GUIDELINES
Dexamethasone is a generic steroid widely used in other diseases to reduce inflammation. Some studies have shown that it may be beneficial in people with severe COVID-19, but it may be ineffective in people with a milder case of the disease.
In its updated guidelines on Aug. 31, the NCID said that based on the most recent data, dexamethasone should be considered for patients with more severe COVID-19.
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“The results of several important studies for COVID-19 treatments have become available since the last review … Based on available data, dexamethasone is recommended for patients with more severe COVID-19 (supplemental oxygen intake or mechanical ventilation ), He said.
The recommendations were made based on the analysis of published clinical trials, cohort studies, as well as guidelines from society and professionals related to the treatment of COVID-19. Each recommendation was also discussed with a committee of experts and evaluated for conflicts of interest.
A quick review of COVID-19 by the Ministry of Health (MOH) and the Agency for the Effectiveness of Care (ACE), first published on June 24 and updated on July 23, also noted that preliminary findings from a A trial in the UK found that dexamethasone could reduce mortality in patients with severe COVID-19.
The full spectrum of COVID-19 infection ranges from asymptomatic illness to mild respiratory tract illness, severe pneumonia, acute respiratory distress syndrome, multi-organ failure, and death.
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The clinical presentation of some critically ill patients with COVID-19 suggests a “cytokine storm syndrome” or a hyperinflammatory state in which the immunosuppressive effects of corticosteroids may be beneficial, the MOH-ACE review said.
Preliminary findings from the trial, which involved more than 11,500 patients, found that dexamethasone reduced the absolute risk of mortality at 28 days, and patients who received mechanical ventilation achieved the greatest benefit, according to the review.
Discussions about dexamethasone recently resurfaced when US President Donald Trump’s doctors said the US President received dexamethasone due to “transient low oxygen levels.”
This has raised concerns among some members of the medical community about the severity of Trump’s illness.
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