Dexamethasone: Another turning point in the COVID-19 pandemic, or another colossal disappointment?

Today a press release was posted that claimed the use of the generic, anti-inflammatory corticosteroid dexamethasone could reduce mortality from severe COVID-19 lung infection by 1/3. This was remarkable given that this drug is well known and already available in large supply. It would cost less than $50 for a course of treatment. The side effects are defined and easily tolerated given the course of treatment proposed. 

If true, this finding would be a transforming treatment for severe COVID-19 lung disease. This drug would substantially reduce mortality in the sickest patients and could be employed immediately. Unlike vaccines or newly developed drugs, this therapy could be used in all patients and change the outlook for thousands of currently infected individuals with COVID-19. 

My post is late today despite the importance of this announcement. That was because I waited all day to try and get scientific verification for the findings in the press release. That confirmation never came.

The press release, stated that this was a controlled trial that indicated simply adding treatment with the steroid dexamethasone to patients with severe respiratory symptoms from COVID-19, could reduce mortality from the infection by up to 1/3. While the trial is registered on the FDA site www.clinicaltrials.gov, there is no specific data from the study that has been released.

The good news is that this is a remarkable finding that could incredibly improve outcomes for patients with severe respiratory symptoms from COVID-19. In addition, this was a controlled trial, with a non-treatment group. The trial involved excellent and well-known investigators who should be able to a properly conducted clinical trial. 

Again, the difficult problem is that none of the data associated with the trial was released; there was this simply a press release outlining the putative results. The trial was also “opened labelled,” not placebo controlled or blinded, so the investigators knew who was getting the trial drug. This could set up for bias in the investigators, who could not help but want the drug to work.

In addition, there may be differences in the disease severity in the control and drug treatment groups that relate to the success of the treatment. Since we cannot review the data, these biases are unknown. Given these concerns, there were a plentitude of negative responses on social media. 

I have stated my distaste for publishing research by press release. This press release is in some ways the worst example, since it has the most potential benefit if correct. That also means it will create the most distrust and cynicism if it does not turn out to be accurate. It could be worse than the hydroxychloroquine debacle since the benefit and ease of use are so great. Of course, there is no possible way to evaluate the veracity of this claim. 

Let’s keep an open mind until the data is released and hope for the best, while planning for the worst for COVID-19 patients. I for one am getting weary of dashed hopes.