With World Health Organization (WHO) warning that the COVID-19 pandemic is “still accelerating,” it will still be months before safe and effective new drugs and vaccines against COVID-19 become available. So efforts have been underway to see if any existing drugs or therapeutics, which are already available, can be repurposed to help with the crisis.
Until now supportive care, including the use of ventilators, supplemental oxygen, and treatment with the drug remdesivir, have been the main options in treating people who are hospitalised with COVID-19, to reduce mortality and enhance recovery. However, now there is evidence that a drug that has been used for decades to treat a whole host of diseases, from asthma to arthritis, could also be used as a treatment for COVID-19 – and it is available straightaway.
This drug, dexamethasone, has proven effective in COVID-19 patients that are seriously ill, hospitalised and on ventilators, reducing deaths by a third, and by a fifth in COVID-19 patients receiving other kinds of breathing support. These findings are from the Recovery (Randomised Evaluation of COVID-19 therapy) trial, conducted by the University of Oxford. The trial only included people who had been hospitalised and for those who did not require breathing support no benefit was found.
When the novel coronavirus infects a person, their immune system can end up aggressively overworking to fight the virus – potentially causing unintentional damage to the body. This low-dose steroid anti-inflammatory drug appears to help by suppressing this immune system overreaction.
Dexamethasone is low-cost and has been on the market since the 1960s, meaning that it is readily available and in adequate supply. Used to treat autoimmune diseases, such as lupus and arthritis, as well as asthma, it is paramount that the medication remains available to people with these health conditions. However, following the publicity this groundbreaking research has attracted, hoarding and speculative procurement may have already begun, although it is too early to say if this will lead to a global shortage.
As the race to develop COVID-19 vaccines continues, these findings have been welcomed by the WHO, which has had the drug on its Model List of Essential Medicines since 1977. As it’s been on the market for several decades, the medication is off-patent and can be manufactured globally. According to South Africa’s Minister of Health, Zweli Mkhize, there are three major suppliers of intravenous dexamethasone in the country, with one manufacturer already supplying its oral version all over the world.
The affordability of dexamethasone is also key, as the daily dose of medicine starts at around £5.40 per patient in the UK, with treatment lasting for up to ten days. Studies and trials of therapies such as dexamethasone are crucial to foster survival and recuperation in coronavirus patients who are in critical condition as research and development is ongoing for COVID-19 vaccines. The Gavi COVAX AMC will play a significant role in ensuring that these vaccines reach people who need them most, once available, especially in low- and middle-income countries.
COVID-19 vaccines will have an essential role to play in ending the crisis once available. But in the meantime, a drug like dexamethasone, which is already in good supply and low cost, could prove valuable in reducing mortality, saving many thousands of lives in the interim.