Dexamethasone in severe COVID-19 infection: A case series

Hassan, Mohamed Eliwa; Hasan, Hasan Msn; Sridharan, Kannan; Elkady, Adel; ElSeirafi, Mohamed M

doi:10.1016/j.rmcr.2020.101205

Cited by 10 publications

(9 citation statements)

References 8 publications

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“…Expectedly, high-dose, short-term corticosteroid therapy in early respiratory distress has been associated with better prognosis [118]. Several clinical reports have demonstrated that the use of corticosteroids in severe COVID-19 provides multiple clinical benefits, including reductions in the need for and duration of invasive ventilation [119][120][121][122].…”

Section: Corticosteroidsmentioning

confidence: 99%

Clinical Management of COVID-19: A Review of Pharmacological Treatment Options

et al. 2021

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Since the outbreak and subsequent declaration of COVID-19 as a global pandemic in March 2020, concerted efforts have been applied by the scientific community to curtail the spread of the disease and find a cure. While vaccines constitute a vital part of the public health strategy to reduce the burden of COVID-19, the management of this disease will continue to rely heavily on pharmacotherapy. This study aims to provide an updated review of pharmacological agents that have been developed and/or repurposed for the treatment of COVID-19. To this end, a comprehensive literature search was conducted using the PubMed, Google Scholar, and LitCovid databases. Relevant clinical studies on drugs used in the management of COVID-19 were identified and evaluated in terms of evidence of efficacy and safety. To date, the FDA has approved three therapies for the treatment of COVID-19 Emergency Use Authorization: convalescent plasma, remdesivir, and casirivimab/imdevimab (REGN-COV2). Drugs such as lopinavir/ritonavir, umifenovir, favipiravir, anakinra, chloroquine, hydroxychloroquine, tocilizumab, interferons, tissue plasminogen activator, intravenous immunoglobulins, and nafamosat have been used off-label with mixed therapeutic results. Adjunctive administration of corticosteroids is also very common. The clinical experience with these approved and repurposed drugs is limited, and data on efficacy for the new indication are not strong. Overall, the response of the global scientific community to the COVID-19 pandemic has been impressive, as evident from the volume of scientific literature elucidating the molecular biology and pathophysiology of SARS-CoV-2 and the approval of three new drugs for clinical management. Reviewed studies have shown mixed data on efficacy and safety of the currently utilized drugs. The lack of standard treatment for COVID-19 has made it difficult to interpret results from most of the published studies due to the risk of attribution error. The long-term effects of drugs can only be assessed after several years of clinical experience; therefore, the efficacy and safety of current COVID-19 therapeutics should continue to be rigorously monitored as part of post-marketing studies.

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Section: Corticosteroidsmentioning

confidence: 99%

Clinical Management of COVID-19: A Review of Pharmacological Treatment Options

et al. 2021

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“…Dexamethasone treatment in CoVID-19 patients who were receiving mechanical ventilation support results in lower mortality rate 123 . Severe CoVID-19 cases have been brought to remission state after 6 mg once a day intravenous administration of dexamethasone 124 .…”

Section: Is Butyrate An Alternative To Dexamethasone?mentioning

confidence: 99%

“…Dexamethasone is indicated as a therapeutic option for immune thrombocytopenic purpura associated with CoVID-19 124 , 125 . Administration of dexamethasone before 30 hours of ARDS onset can significantly reduce the period of mechanical ventilation and mortality 12 .…”

Section: Is Butyrate An Alternative To Dexamethasone?mentioning

confidence: 99%

“…High dose pulse therapy of dexamethasone increased the survival rate in CoVID-19 patients presented with hyperinflammation 126 . However, dexamethasone, a broad spectrum immunosuppressant, inhibits lymphocytes function and prevents macrophage mediated removal of apoptotic cells, which leads to reduced viral shedding and increases subsequent viremia in mild to moderately ill CoVID-19 patients 124 , 127 , 128 . Prolonged use of corticosteroids is associated with serious adverse effects such as short-term hyperglycaemia, cataracts, glaucoma, hypertension, psychological effects, weight gain, increased risk of secondary infections and osteoporosis 13 , 129 .…”

Section: Is Butyrate An Alternative To Dexamethasone?mentioning

confidence: 99%

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Is butyrate a natural alternative to dexamethasone in the management of CoVID-19?

et al. 2021

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Coronavirus disease 2019 (CoVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 has affected more than 100 million lives. Severe CoVID-19 infection may lead to acute respiratory distress syndrome and death of the patient, and is associated with hyperinflammation and cytokine storm. The broad spectrum immunosuppressant corticosteroid, dexamethasone, is being used to manage the cytokine storm and hyperinflammation in CoVID-19 patients. However, the extensive use of corticosteroids leads to serious adverse events and disruption of the gut-lung axis. Various micronutrients and probiotic supplementations are known to aid in the reduction of hyperinflammation and restoration of gut microbiota. The attenuation of the deleterious immune response and hyperinflammation could be mediated by short chain fatty acids produced by the gut microbiota. Butyric acid, the most extensively studied short chain fatty acid, is known for its anti-inflammatory properties. Additionally, butyric acid has been shown to ameliorate hyperinflammation and reduce oxidative stress in various pathologies, including respiratory viral infections. In this review, the potential anti-inflammatory effects of butyric acid that aid in cytokine storm depletion, and its usefulness in effective management of critical illness related to CoVID-19 have been discussed.

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“…To date, there are no exact specific antiviral treatments or vaccines for the COVID-19 disease (M. Kumar et al, 2020a , 2020b ). Therefore, to treat or alleviate its symptoms, some drugs are being clinically evaluated, including chloroquine (CQ) and hydroxychloroquine (HCQ) ( Borba et al, 2020 ; Gao et al, 2020 ; Magagnoli et al, 2020 ; Tang et al, 2020 ), azithromycin (AZT) ( Arshad et al, 2020 ; Dubernet et al, 2020 ), ivermectin (IVM) ( Caly et al, 2020 ; Yang et al, 2020 ), dexamethasone (DEX) ( Hassan et al, 2020 ; Johnson and Vinetz, 2020 ; Lester et al, 2020 ; Selvaraj, 2020 ) and some HIV antivirals ( Agrawal et al, 2020 ; Alvi et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%