NEW YORK - Several US hospitals in
states with fresh surges of Covid-19 cases have started treating
their sickest patients with dexamethasone rather than await
confirmation of preliminary results of a study by British
researchers, who said the inexpensive steroid saves lives.
The move illustrates how the pandemic is changing the way
hospitals work, at least regarding Covid-19 patients.
Traditionally, doctors wait for detailed data to be
published in a peer reviewed journal - or for guidelines from
medical societies - before embracing a new treatment, so they
can better gauge the risks against the drug's benefits. The
urgency of the coronavirus pandemic and lack of other treatments
has altered those calculations.
Dexamethasone is the first drug shown to lower the risk of
death in severely ill Covid-19 patients in what researchers
running the trial hailed as a "major breakthrough."
The Oxford University researchers said in a news release
that dexamethasone reduced death rates by around a third among
Covid-19 patients requiring mechanical breathing assistance or
oxygen. Britain's health ministry has already approved its use
in the state-run health service.
"It almost feels unethical not to use the drug," said Dr.
Kartik Cherabuddi, an infectious diseases specialist at the
University of Florida's (UF) medical school.
UF's Gainesville hospital updated its Covid-19 treatment
guidelines as of Tuesday to include using dexamethasone. It
previously used the extremely cheap generic medicine sparingly
for those patients.
Cherabuddi noted that his hospital - and many others -
similarly started treating Covid-19 patients with Gilead
Science's antiviral drug remdesivir based on data from
a news release.
That drug, which unlike dexamethasone was not yet approved
by regulators for any other conditions, shortened hospital
recovery times in a clinical trial. It did not have an effect on
mortality.
Several hospital systems, including New York's Northwell
Health and the University of Washington (UW) had not been using
steroids on Covid-19 patients. There was some concern it could
lead to worse outcomes because it suppresses the immune system.
"For us, the case numbers are low and so there is not much
pressure to do something new," said UW's Dr. Mark Wurfel, who is
eager to see the final data. Places like Florida and Oklahoma,
where Covid-19 hospitalizations are rising, are under more
pressure, he said.
"The urgency of having hundreds, maybe thousands of very
sick Covid-19 patients in hospitals and ICUs changes the calculus.
Many lives could be saved if the trial results are real," Wurfel
added.
AdventHealth, which has nearly 50 hospitals in nine states,
has been using dexamethasone for Covid-19 patients on
ventilators with success since early April, said Eduardo
Oliveira, executive medical director for critical care for
AdventHealth's central Florida region.
At its eight hospitals in the Orlando area, Oliveira said
the mortality rate for patients requiring ventilators was about
26%, "lower than almost every other reported mortality in the
literature right now."
He noted it was difficult to know whether that success was
due to the use of steroids.
After reviewing the British study release and trial
protocols, Advent expanded its dexamethasone use to also
include patients receiving supportive oxygen but not on
ventilators.
Dr. Brent Brown, medical director of University of
Oklahoma's intensive care unit, said his hospital added the
steroid to its treatment guidelines for patients in the ICU this
week. Oklahoma is one of several US states with rapidly rising
coronavirus cases.
"We changed our practice completely. It was kind of an about
face," he said. "But we're delighted to have something that
looks so promising."