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Dexamethasone in the management of covid -19

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2648 (Published 03 July 2020) Cite this as: BMJ 2020;370:m2648

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Re: Dexamethasone in the management of covid -19

Dear Editor
I read with great interest the editorial by Dr Johnson. At present, the only evidence-based antiviral drug treatment available was remdesivir.1 There is still no vaccine for COVID-19. Vaccines for COVID-19 are under development, and the process may take several years. Thus the RECOVERY press release delivered an inspiring message.
Although interim guidance from WHO advises against the use of corticosteroids,2 corticosteroids were still widely used during the early outbreaks of COVID-19 despite uncertainty over their efficacy. Some scholars commented that corticosteroid treatment should not be used for the treatment of COVID-19 outside of a clinical trial because of insufficient evidence exists to recommend corticosteroid treatment at the time.3 On the contrary, Prevention and Control Protocol for the COVID-19 released by the National Health Commission of the People’s Republic of China recommended corticosteroid treatment4. According to the expert consensus statement,5 corticosteroids should be used when meeting the following basic principles: Firstly, the benefit outweighs the risk. Secondly, only used in critically ill patients with COVID-19. Thirdly, the dosage should be low-to-moderate (≤0.5㎎/㎏ per day methylprednisolone or equivalent). The expert consensus use is consistent with RECOVERY findings to some degree.
Corticosteroid treatment is a double-edged sword. There is a major concerns about the potential risks associated with high-dose corticosteroids in treating COVID-19. More effort should be made to answer unresolved questions in future studies including the optimal type of corticosteroid nor timing, dose, or duration.

References
1. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 — Preliminary Report. New England Journal of Medicine 2020 doi: 10.1056/NEJMoa2007764
2. WHO. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance. 2020 [Available from: https://apps.who.int/iris/handle/10665/330893.
3. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. The Lancet 2020;395(10223):473-75. doi: 10.1016/S0140-6736(20)30317-2
4. PRC NHC. New Coronavirus Pneumonia Prevention and Control Protocol for the novel coronavirus disease 2019 (COVID-19): National Health Commission of the People’s Republic of China; 2020 [Available from: http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb19... accessed July 14.
5. Zhao J, Hu Y, Du R, et al. Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia. Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases 2020;43:183-84. doi: 10.3760/cma.j.issn.1001-0939.2020.03.008

Competing interests: No competing interests

16 July 2020
Jianghui Cai
clinical pharmacist
Mi Tang
Chengdu Women’s and Children’s Central Hospital
1617 riyue avenue, qingyang district, Chengdu 610041, China