Trump gets dexamethasone to treat COVID-19. Here’s what we know about the steroid
President Donald Trump’s medical team announced Sunday that Trump has been given a common corticosteroid called dexamethasone, in addition to an “antibody cocktail” and the antiviral drug remdesivir, as part of his COVID-19 treatment.
Trump’s physician, Dr. Sean Conley, told reporters Sunday the decision to put him on the steroid was made after Trump’s oxygen levels dropped to 93% (a healthy oxygen saturation is at least 95%), media outlets reported.
“In response to transient low oxygen levels, as Dr. Conley has discussed, we did initiate dexamethasone therapy, and he received his first dose of that [Saturday],” Dr. Brian Garibaldi, one of the physicians treating Trump at the Walter Reed National Military Medical Center in Bethesda, Maryland, said during Sunday’s briefing, CNN reported.
“Our plan is to continue that for the time being,” Garibaldi added, meaning the president’s medical advisers have decided that the potential benefits of the drug “probably outweighed the risks at this time,” Conley said.
However, both national and global health organizations recommend against the use of dexamethasone for patients like Trump who are not receiving supplemental oxygen or mechanical ventilation.
A study on about 6,000 people with coronavirus showed the steroid provided no survival benefit for patients who did not need supplemental oxygen, according to the National Institutes of Health. The research also revealed the drug introduced “potential harm.”
That’s because giving dexamethasone to a patient with a mild case of COVID-19 can block their immune system’s ability to fight off the virus while it still can, experts say.
“You don’t want to give [dexamethasone] to a patient too early,” Dr. Nahid Bhadelia, medical director of Boston Medical Center’s Special Pathogens Unit, told STAT. “It’s a blunt instrument, so it may suppress a good immune response as well as a bad one.”
Dexamethasone is a cheap drug typically used to treat conditions such as arthritis, allergic reactions, certain bowel disorders, certain cancers and immune system disorders, according to WebMD. It’s known to reduce symptoms such as swelling while decreasing the body’s “natural defensive response.”
Common side effects include upset stomach, headaches, dizziness and trouble sleeping, but many people who use this drug do not have serious reactions.
Patients with severe COVID-19 often develop “a systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction,” the NIH says. So, dexamethasone’s anti-inflammatory properties have been thought to prevent or mitigate these effects for COVID-19 — but only for the sickest patients, experts say.
A major study on the drug showed that about 23% of patients given six milligrams of dexamethasone once a day died within 28 days compared with about 26% of patients receiving standard care.
But the survival benefits were greatest among those who required invasive mechanical ventilation: 29% of patients receiving dexamethasone died within 28 days compared with 41% on standard care.
This is why the World Health Organization “strongly” recommends dexamethasone therapy for patients with severe and critical COVID-19, and offers a “conditional recommendation not to use” the drug in patients with a mild case.
Trump’s doctors said he received oxygen “for about an hour” on Friday, according to STAT, but it remains unclear how severe the president’s illness is.
On Friday, Conley released a health update saying Trump was given an “antibody cocktail,” which studies have shown reduced the viral load and improved symptoms in non-hospitalized COVID-19 patients, McClatchy News reported. It can be administered before someone has been exposed to the coronavirus or as treatment once infected, as is the case with Trump.
Later Friday, Conley announced the president was also given remdesivir, an antiviral drug that has reduced COVID-19 patients’ hospital stays from 15 days to 11 days, but hasn’t been shown to reduce the odds of dying from the virus, according to McClatchy News.
The president has so far been given three experimental drugs with the addition of dexamethasone.
The NIH says taking remdesivir and dexamethasone at the same time “has not been formally studied, but a clinically significant” interaction between the two “is not predicted.”
“[Trump’s] receipt of antibodies on ‘compassionate use’ isn’t unreasonable, though it hasn’t been approved. Nor was giving him IV remdesivir in the White House,” Dr. Bob Wachter, professor and chair of the department of medicine at the University of California, San Francisco, said on Twitter.
“But, because [dexamethasone] suppresses the immune system at a time when we want it to be working at full throttle, the use of [it] in patients not yet requiring oxygen would constitute not only non-evidence based therapy, but one where evidence says it’s likely to be harmful,” Wachter said.
This story was originally published October 5, 2020 at 7:00 PM with the headline "Trump gets dexamethasone to treat COVID-19. Here’s what we know about the steroid."
