Can Dexamethasone Reduce Prolonged COVID-19 Symptoms?

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Infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus responsible for the current 2019 Coronavirus Disease (COVID-19) pandemic, causes a wide range of symptoms. Unfortunately, a minority of patients with COVID-19 must be hospitalized due to progressive respiratory failure with a 20% death rate.

Study: Influence of dexamethasone on persistent symptoms of COVID-19: an observational study. Image source: Kryptograf / Shutterstock.com

background

Many people who survived the acute phase of infection were found to have persistent symptoms known as “long covid” or post-acute episodes of COVID-19 (PASC).

A large randomized study conducted in hospitals in the United Kingdom (UK) during the pandemic showed that the steroid dexamethasone was able to reduce mortality in hospitalized patients in need of oxygen. Although dexamethasone is widely used, little is known about its effects on persistent symptoms after patients recover from COVID-19.

A new study published on the preprint server medRxiv* assesses the symptom burden and quality of life of hospitalized patients eight months after recovery from COVID-19 by comparing people before and after treatment with dexamethasone.

About the study

The current study recruited 198 patients admitted with COVID-19 pneumonia from a single hospital in the UK between April 2020 and August 2020. The inclusion criteria were either a positive polymerase chain reaction test (PCR) against SARS-CoV-2 or a clinical-radiological diagnosis of COVID-19. Patients who received steroid treatment two weeks prior to enrollment or who received long-term steroids were excluded from the study.

Eligible patients were divided into two groups, including a group who received 6 milligrams (mg) of oral dexamethasone once daily and the control group. Both groups consisted of patients with a similar age range, frailty score, the presence of comorbidities and ventilation requirements during enrollment at the start of the study. However, more men and a higher rate of previous chronic lung disease were reported in the control group who did not receive dexamethasone.

Patients in need of oxygen after admission were identified and grouped by whether they were prescribed dexamethasone upon admission. The duration of the dexamethasone course was recorded along with routine clinical and demographic information.

All patients were followed up either by telephone or in person for eight months after their recovery from COVID-19. Patients were asked to complete a short survey that included questions about their quality of life and a review of persistent symptoms.

Study results

The results showed that in the two groups, 68% of patients reported at least one persistent symptom eight months after infection. The most commonly reported symptoms were fatigue, insomnia, and shortness of breath. However, the patients who received dexamethasone reported fewer symptoms compared to the control group.

Symptoms at 8-month follow-up in comparison of the dexamethasone group (orange) with no dexamethasone group (green).

The mental and physical composite scores extracted from the questionnaire showed no significant difference between the dexamethasone and control groups.

However, the outcome can have several implications. First, the patients who received the steroid were the most likely to recover regardless of the steroid used. Second, the use of dexamethasone increased during the pandemic; therefore the dexamethasone group was recruited later than the control group.

Therefore, the reduced symptoms in the dexamethasone group could be due to an overall improvement in care that led to a reduction in long-term symptoms. Third, the results could be due to more acute patients dying and not available for follow-up visits. Fourth, the association between dexamethasone and reduced mortality could be accidental.

The current study had several limitations. First, the study sample size was small and resulted in minimal data loss. Second, the study is limited to those patients who needed oxygen while in hospital. Third, the study harmed hospital patients who did not need oxygen.

*Important NOTE

medRxiv publishes preliminary scientific reports that have not been peer-reviewed and should therefore not be considered conclusive, that guide clinical practice / health-related behavior or should be treated as established information.

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