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 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 <GILD.O>
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.
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"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 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 U.S. 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."
(Reporting by Michael Erman, editing by Peter Henderson and Bill Berkrot)
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