What role can dexamethasone play now that Belgium is in the second wave of the corona pandemic? Five questions for Philippe Jorens, head of the intensive care department of the university hospital of Antwerp.
In mid-June, there was a sigh of relief when British scientists announced they had discovered ‘a breakthrough’ in the fight against Covid-19. Their study showed that the risk of death in covid-19 patients could be reduced by up to a third when given the drug dexamethasone. To prevent shortages, the Federal Agency for Medicines and Health (FAMHP) placed the medicine on the list of products subject to controlled distribution one week after the publication of the study.
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In mid-June, there was a sigh of relief when British scientists announced they had discovered ‘a breakthrough’ in the fight against Covid-19. Their study showed that the risk of death in covid-19 patients could be reduced by up to a third when given the drug dexamethasone. To prevent shortages, the Federal Agency for Medicines and Health (FAMHP) placed the medicine on the list of products subject to controlled distribution one week after the publication of the study. ‘As long as we have to wait for a vaccine or a conclusive medicine, dexamethasone is the only product that has really remained firm in the entire discussion about medicines,’ says Philippe Jorens, head of the intensive care department of the University Hospital of Antwerp. What exactly is dexamethasone? Philippe Jorens: ‘Dexamethasone belongs to the cortisone family. It is a synthetic derivative of cortisol, the cortisone that is produced in our adrenal cortex. That family is very useful for suppressing inflammation. When we noticed in March that the levels of inflammation biomarkers in the blood of covid-19 patients were exceptionally high, we started to administer a cortisone almost immediately. In addition, cortisones also cause fluid to build up in the body – often the reason why some chronic lung patients on this type of medicine look bloated. Contrary to most cortisones, dexamethasone hardly causes water to accumulate. The drug does generate the classic side effects, for example that other infections are more likely to break through. ‘ Why was the drug ‘rediscovered’ only in June? Jorens: Although the drug was often used for rheumatism treatments, it had fallen into disuse over the years. Several months before the corona pandemic, a large-scale study showed that dexamethasone had a positive impact on non-covid-related lung damage. Since then, the drug has been given a bit of a second life. Since the publication of the British study, many other critical studies have appeared about the drug. Nevertheless, it has become clear in recent weeks that it is the only product that has more or less remained intact in the entire discussion about medicines with a beneficial effect in covid-19. ‘ How often and when is dexamethasone used? Jorens: Very often. A course lasts five days, but in patients where other inflammations largely disappear, we sometimes even administer (another) cortisone a second time. There is still debate about the best time to administer. We keep it for the most sick patients in intensive care, other hospitals still need it for patients before artificial respiration is needed. The problem is that cortisones also weaken the muscles, which is not particularly beneficial for immobile patients who have to spend weeks on end in hospital beds. Do we notice that the use of dexamethasone reduces the mortality rate? Jorens: Although we have the feeling that it is, we cannot say for sure at the moment. A lot of factors come into play: age, weight, gender, underlying conditions, and so on that all determine the prognosis. In addition, people not only die, but sometimes also after intensive care. Finally, we also used other cortisones before, which makes it difficult to estimate whether any decrease can be attributed to dexamethasone or cortisones in general. We therefore have to wait for studies that can provide a better insight into the effects of the drug in the longer term. When can we expect them? Jorens: That will probably take a while. In the early stages of the virus, we had no choice but to compare the effects of cortisone with a placebo. However, we will have to discard a new drug against dexamethasone, which is already considered by many as ‘a must’. Therefore, we will therefore need a much larger test population in order to establish a significant distinction.
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