A preprint containing the full dataset was published on 22 June 2020, and demand for dexamethasone surged after publication of the preprint. The preliminary report was published in The New England Journal of Medicine on 18 July 2020. The final report was published in February 2021.The World Health Organization (WHO) states that dexamethasone should be reserved for seriously ill and critical patients receiving COVID-19 treatment in a hospital setting, and the WHO Director-General stated that "WHO emphasizes that dexamethasone should only be used for patients with severe or critical disease, under close clinical supervision. There is no evidence this drug works for patients with mild disease or as a preventative measure, and it could cause harm." In July 2020, the WHO stated they are in the process of updating treatment guidelines to include dexamethasone or other steroids. In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19.In July 2020, the European Medicines Agency (EMA) started reviewing results from the RECOVERY study arm that involved the use of dexamethasone in the treatment of patients with COVID-19 admitted to the hospital to provide an opinion on the results and in particular the potential use of dexamethasone for the treatment of adults with COVID-19. In September 2020, the EMA received an application for marketing authorization of dexamethasone for COVID-19. Society and culture
Price
Dexamethasone is inexpensive. In the United States a month of medication is typically priced less than US$25. In India, a course of treatment for preterm labor is about US$0.50.
A meta-analysis of seven clinical trials of critically ill COVID-19 participants, each treated with one of three different corticosteroids found a statistically significant reduction in death. The largest reduction was obtained with dexamethasone (36% compared to placebo).In September 2020, the European Medicines Agency (EMA) endorsed the use of dexamethasone in adults and adolescents, from twelve years of age and weighing at least 40 kilograms (88 lb), who require supplemental oxygen therapy. Dexamethasone can be taken by mouth or given as an injection or infusion (drip) into a vein.In November 2020, the Public Health Agency of Canadas Clinical Pharmacology Task Group recommended dexamethasone for hospitalized patients requiring mechanical ventilation. Although dexamethasone, and other glucocorticoids, reduce mortality in COVID-19 they have also been associated with an increased risk of secondary infections, secondary infections being a significant issue in critically ill COVID-19 patients.The mechanism of action of dexamethasone involves suppression of late-stage interferon type I programs in severe COVID-19 patients. Endocrine
Dexamethasone is the treatment for the very rare disorder of glucocorticoid resistance.In adrenal insufficiency and Addisons disease, dexamethasone is prescribed when the patient does not respond well to prednisone or methylprednisolone.It can be used in congenital adrenal hyperplasia in older adolescents and adults to suppress Adrenocorticotropic hormone (ACTH) production. It is typically given at night. Pregnancy
Dexamethasone may be given to women at risk of delivering prematurely to promote maturation of the fetus lungs.