SINGAPORE: The steroid known as dexamethasone is recommended for patients with “severe” COVID-19 infection requiring supplemental oxygen or mechanical ventilation, according to interim treatment guidelines updated by the National Centre for Infectious Diseases (NCID) in August.
The guidelines provide updated evidence-based recommendations on the management of patients with COVID-19 in Singapore.
NCID's clinical director had said in response to queries from CNA in June that steroids were not routinely recommended for COVID-19 patients in Singapore at the time because of potential harmful effects.
NCID INTERIM TREATMENT GUIDELINES
Dexamethasone is a generic steroid widely used in other diseases to reduce inflammation. Some studies have shown that it can be beneficial in people with severe COVID-19, but may be ineffective in people with a milder case of the illness.
In its updated guidelines on Aug 31, NCID said that based on latest data, dexamethasone should be considered for patients with more severe COVID-19.
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"Results from several important studies for treatments for COVID-19 have been made available since the last review ... Based on available data, dexamethasone is recommended for patients with more severe COVID-19 (receipt of supplemental oxygen or mechanical ventilation), it said.
The recommendations were made based on the analysis of published clinical trials, cohort studies, as well as society and professional guidelines related to the treatment of COVID-19. Each recommendation was also discussed with an expert committee and screened for conflicts of interest.
A Ministry of Health (MOH) and Agency for Care Effectiveness (ACE) COVID-19 rapid review - first published on Jun 24 and updated on Jul 23 - also noted that preliminary findings from a trial in the United Kingdom found that dexamethasone could reduce mortality in patients with severe COVID-19.
The full spectrum of COVID-19 infection ranges from asymptomatic disease to mild respiratory tract illness to severe pneumonia, acute respiratory distress syndrome, multiorgan failure and death.
Clinical presentation of some critically ill patients with COVID-19 suggest a “Cytokine Storm Syndrome” or hyperinflammatory state in which the immunosuppressive effects of corticosteroids may be beneficial, said the MOH-ACE review.
Preliminary findings from the trial, which involved more than 11,500 patients, found that dexamethasone reduced the absolute risk of 28-day mortality, with patients receiving mechanical ventilation achieving the greatest benefit, the review said.
Discussions about dexamethasone recently resurfaced when doctors to US President Donald Trump said the US president was given dexamethasone because of "transient low oxygen levels”.
This has led to concerns among some in the medical community about the severity of Trump's illness.