Dexamethasone

In vitro manifests ACE2 agonist activity in GES-1 cells and decreases IL-6 secretion in M1 macrophages.

Primary endpoint 28-day mortality; secondary endpoint hospitalization duration. Dosage 6 mg daily. Sample size 2104 patients (+4321 control). Dexamethasone reducchanical vented 28-day mortality among those receiving invasive meilation or oxygen at randomization, but not among patients not receiving respiratory support.

Enrollment halted due to the RECOVERY Collaborative Group announcement that dexamethasone reduces mortality in patients with COVID-19. Preliminary results show statistically significant increase in days without mechanical ventilation within 28-days of treatment. No significant difference in all-cause mortality at day 28 was observed between the dexamethasone and the control group. Sample size: 151 + 148 control. Dosage: 20 mg daily on days 1-5; 10 mg daily on days 6-10 or until ICU discharge. Endpoint: Ventilator-free days during the first 28 days (primary).

Possible protective effect in patients with ARDS related to the SARS-CoV-2 infection. Sample size: 5. Dosage: 6 mg/day.

Predicted to bind the SARS-CoV-2 3C-like protease, besides the host's glucocorticoid receptor.

Marked improvement in supplementary oxygen requirement, temperature, and CRP. Equally effective as methylprednisolone in moderate to severe COVID-19.
Sample size: 35 (dexamethasone) + 65 (methylprednisolone). Dosage: 8 mg/kg daily for 5 days.

Considered by the authors to be among the most relevant drugs identified in a machine-learning algorithm-based screening of compounds which considers causal protein-protein interactions, known drug targets, and specific signalling circuits in the COVID-19 disease map.

Prolonged latency of death in a murine hypoxic model with possible implication for COVID-19.

In combination with anakinra. Rapid clinical improvement in a COVID-19 patient with acute respiratory failure and cardiogenic shock. Dosage: Single IV dose.

Computational analysis predicted binding between dexamethasone (DEX) and ACE2 receptor. Binding constant (KD) was measured to be ca. 9.03 μM in vitro. There was an increase in retention time of DEX on an ACE2 chromatography column compared to other glucocorticoids. DEX significantly inhibited SARS-CoV-2 pseudovirus entrance into cells expressing ACE2 receptor (entrance ratio reduced to ca. 41% at 10 μM DEX).

There was a statistically significantly lower mortality in treated patients who required respiratory support. The association between mortality and dexamethasone use in the subgroup of patients who did not require mechanical ventilation was insignificant. Sample size: 171 (63 of whom required respiratory support) + 12.039 control (1.129 of whom required respiratory support). Dosage: Ranging from 10 mg daily for 6 days to 20 mg daily for 5 days followed by 10 mg daily for 5 days. Administered IV or orally. Primary outcome: Time to death.

Compared to tocilizumab therapy, dexamethasone therapy in critically ill COVID-19 patients was associated with significantly better survival and other clinical outcomes. Sample size: 63 dexamethasone + 46 tocilizumab. Dosage: 4 mg/kg daily on days 1 to 3 and 8 mg daily on days 4 to 13. Primary outcome: Survival.

Combined with baricitinib and remdesivir, the treatment mostly led to a favourable clinical outcome. Sample size: 45. Dosage: 6 mg IV daily for 10 days or until hospital discharge. Main outcome: Hospitalization length, shock presence, and thrombosis occurrence.

The combination of baricitinib, remdesivir and dexamethasone seemed to generally lead to improved survival in hospitalized COVID-19 patients. Sample size: 83 yes + 17 no. 

The combination of baricitinib, remdesivir and dexamethasone seemed to generally lead to positive clinical outcomes in the treatment of severe COVID-19 patients. There was no control group, however. Sample size: 44. Dosage: 6 mg daily for up to 10 days.