Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the virus that is responsible for the current coronavirus disease 2019 (COVID-19) pandemic, can cause many symptoms. A small proportion of COVID-19 patients need hospitalization because of progressive respiratory failure, and a 20% mortality rate.
Study A study of observation on the effects of dexamethasone on persistent symptoms of COVID-19. Image Credit: Cryptographer / Shutterstock.com
Many individuals who survived the acute phase of the illness were diagnosed with long-term symptoms, which are referred to as ‘long Covid or post-acute sequelae of COVID-19 (PASC).
A large-scale randomized study was conducted at UK (U.K.), hospitals during the outbreak. It revealed that dexamethasone can reduce mortality in patients admitted to hospitals and require oxygen. Although dexamethasone is used widely but little is known about its impact on prolonged symptoms following recovery from COVID-19.
A new study that was published on the preprint server medRxiv* evaluates the burden of symptoms and quality of life of hospitalized patients eight months after recovering from COVID-19. The study compares the patients prior to and after treatment with dexamethasone.
About the study
The study involved 198 patients admitted with COVID-19 pneumonia at one hospital in the U.K. Between April 2020 and August 2020. The inclusion criteria were either a positive polymerase chain reaction (PCR) test against SARS-CoV-2 or a clinical-radiological diagnosis of COVID-19. The study excluded patients who had received steroids within the first two weeks of admission, as well as those taking long-term steroids.
The patients who were eligible were split into two groups including one group receiving 6 milligrams (mg) of oral dexamethasone every day, and the other group. Both groups comprised patients who had a similar age range frailty score, the presence of comorbidities, and requirement for ventilation during admission at baseline. However, more men and a higher prevalence of prior chronic lung disease were found in the control group who did not receive dexamethasone.
Patients who required oxygen after admission were identified and grouped according to the dexamethasone dose prescribed at admission. The duration of the dexamethasone regimen was recorded, as was routine demographic and clinical information.
All patients were followed for eight months after they had recovered from COVID-19 either through telephone or in-person visits. Patients were asked to take an informal survey, which asked about their daily living and a review of their ongoing symptoms.
The results showed that 68% patients suffered from at least one persistent symptom 8 months after the infection. The most frequently reported symptoms included insomnia, fatigue, and breathlessness. However, those who received dexamethasone reported fewer symptoms as compared to the control group.
Signs and symptoms at 8-month follow-up comparing the dexamethasone group (orange) to no dexamethasone group (green).
The physical and mental composite scores obtained from the questionnaire indicated no significant difference between the dexamethasone and control groups.
However, there are several implications of the result. The first is that patients who received the steroids were more likely to recover, regardless of the dose of steroid they received. The use of dexamethasone was also greater during the time of the pandemic. Thus, the dexamethasone-treated group was recruited later that the control group.
Therefore, the reduced symptomatology of the dexamethasone group could be due to improvements in care that led to a reduction of long-term symptoms. Third, it could be that more acute patients are dying and are not available for follow-up. Fourth It is possible the link between dexamethasone treatment and lower mortality could be accidental.
There were a few issues with the current study. The sample size for the study was very small, resulting in very little loss of data. The study was limited to patients who require oxygen during hospitalization. Third, the trial caused harm to patients in hospitals who didn’t need oxygen.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
Content Source: https://www.news-medical.net/news/20211124/Can-dexamethasone-reduce-prolonged-COVID-19-symptoms.aspx