People are flocking again to news that Dexamethasone is a CoviD-19 cure. And again, we reiterate, like the repurposed drugs Hydroxychloriquine and Remdesivir – it’s not. Lets go to basics first: Dexamethasone is a steroid.
What are steroids?
Basically our bodies produce steroid hormones, of which there are two types: corticosteroids from the adrenal cortex , and sex steroids from our reproductive glands.
According to a study by Frye CA in 2009 titled “Steroids, reproductive endocrine function, and affect, A review”, steroid hormones help control metabolism, inflammation, immune functions, salt and water balance, development of sexual characteristics, and the ability to withstand illness and injury.
Steroids have been produced artificially to duplicate the actions of naturally occurring steroids in the body, and is the basis for their medication, the lack or excess thereof of steroid hormones bring about adverse effects in the body and is mainly corrected by supplementing in the correct steroid medication that is missing or to counteract the excess – thus it has been known, that the lack or excess of naturally occurring steroids in our body could harm us, likewise will this synthetic steroid medications when not used properly.
That is why steroid medications need prescription and monitoring by physicians, as abuse of steroids could potentially lead to serious adverse effects and ultimately death.
Our media has a responsibility to make sure that the news they deliver is appropriately understood by the masses.
It is also common knowledge that these news outlets are sometimes commissioned by researchers who study the drugs in order to pique public interest and garner more support for further study and research so it’s now the reader’s responsibility to look further into the things they understand only as “Dexamethasone, a CoviD-19 Cure”.
People are desperately looking for a pop a pill and you’re safe regimen but to the best of our knowledge, besides certain vaccines, there is actually no such drug acting like a magic pill for any disease.
Let’s name a few steroid hormones to introduce us to its vastness, some you’ve probably heard of: Aldosterone, Cortisol, Progesterone, Estrogen and Testosterone are but a few of the naturally occurring steroid hormones, while artificially produced and widely used in medications include Prednisone and what we are going to discuss today, Dexamethasone.
There are two classes of non-sex steroids, Glucocorticoids and Mineralocorticoids. It’s important to note this as there is a stark difference in both. Sex steroids are aptly named gonadocorticoids, from the word gonad which means reproductive glands.
Glucocorticoids are named after their role in glucose metabolism and metabolism in general. Their main function is in metabolism and in immune responses such as immune suppression or anti-inflammatory processes.
Mineralocorticoids on the other hand primarily involve the regulation of electrolyte and water balance in the body.
Dexamethasone is a synthetic Glucocortiocoid, It is listed in WHO’s 2019 list of essential medicines. According to ClinCal.com which ranks drugs based on the number of prescriptions given, In 2017, it was the 321st most commonly prescribed medication in the United States, with more than one million prescriptions.
Dexamethasone is used to treat a wide variety of medical illnesses and conditions including rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, and along with antibiotics in tuberculosis. It is also used in cancer treatment.
It may be taken by mouth, as an injection into a muscle, or intravenously and the effects of dexamethasone are frequently seen within a day and last for about three days.
While for the lay, this seems to be a wonder drug – it’s not without its side effects. Listed in the electronic medicine compendium are the various side effects of the drug in both its injected and oral form. The long-term use of dexamethasone may result in thrush (a fungal infection in the mouth that is characterized by white growths), bone loss, cataracts, easy bruising, or muscle weakness. According to drugs.com Dexamethasone is also used in pregnancy to improve the outcomes of babies, but it’s categorized as category C drug in the assessment of fetal risks in which its uses benefits must outweigh the risks.
The adverse effects of dexamethasone is numerous. Ranging from, but is not limited to Stomach upset, headache, dizziness, menstrual changes, trouble sleeping, increased appetite, or weight gain.
We’ve barely tackled the beauty and horror of steroids, but these information is enough introduction to know that these drugs aren’t to be taken lightly and there’s a reason why they end up in hundred pages of medical books for their uses and effects alone.
Dexamethasone in CoviD-19
Investigators working on the U.K.-based RECOVERY trial announced that dexamethasone improved patients’ chances of surviving severe CoviD-19. During the study, about 2,100 CoviD-19 patients were treated with dexamethasone for 10 days.
Patients on mechanical ventilation who were given dexamethasone were 35% less likely to die compared to patients on ventilators who did not get the treatment. In patients on less invasive forms of breathing support, dexamethasone decreased the risk of death by 20%. Those are promising findings, and it makes sense that an anti-inflammatory drug would be effective against a disease that’s most harmful when it spurs excess inflammation in the body.
It is important to note that patients only suffering from milder cases of CoviD-19, especially those who did not require any respiratory help saw no improvements after taking the steroid.
Mike Ryan, executive director of the World Health Organization’s Health Emergencies Programme, stated in a briefing that “It’s exceptionally important in these cases that the drug is reserved for severely ill and critical patients who can benefit from this clearly,”
There’s a big caveat: the researchers released only a summary of the data, rather than a complete, peer-reviewed paper. “This is a (trial) result that shows that if patients who have CoviD-19 and are on ventilators or are on oxygen are given dexamethasone, it will save lives, and it will do so at a remarkably low cost,” said Martin Landray, an Oxford University professor co-leading the RECOVERY trials.
What we’d like to relay is caution. Interest for Dexamethasone surged after these findings, and there have been reports of people stockpiling and allegedly selling dexamethasone online. The drug if taken without the correct prescription actually harms the body, and cannot be used as prophylaxis for CoviD-19. A healthy body bathed with steroids that can potentially inhibit the immune system may actually lead to one being more susceptible, not just for CoviD-19 but other diseases, as one known side effects of steroids are fungal infections.
Hydroxychloriquine serves as a precautionary tale. It was previously marketed as a “miracle drug” as well, but a recently two prominent medical journals, the Lancet and the New England Journal of Medicine, had to retract high-profile studies involving Hydroxychloriquine due to its safety concerns.
While we know that the clock is ticking, it’s also imperative that we don’t jump into new findings with haste.
The damage done when concluding on things that are yet to be fully proven in any aspect of our lives undermine what we ultimately want to achieve.