Dexamethasone
Recent studies have demonstrated great interest in the role of corticosteroids to attenuate the pulmonary and systemic damage in COVID-19 patients because of their potent anti-inflammatory and antifibrotic properties, especially dexamethasone, a synthetic corticosteroid which is on the list of essential medicines of the World Health Organization and is readily available worldwide at low cost. This drug acts as a broad-spectrum immunosuppressor and has greater activity in inflammatory and autoimmune conditions (402, 403).
Recently, the randomized RECOVERY study, conducted by the University of Oxford, declared dexamethasone as the world’s first treatment proven effective in reducing the risk of death among severely ill COVID-19 patients. The trial accompanied a total of 2104 patients treated with dexamethasone and 4321 who received conventional care. The dexamethasone group showed reduced 28-day mortality in COVID-19 patients receiving invasive mechanical ventilation or oxygen therapy without invasive mechanical ventilation, but not in patients who were not receiving any respiratory support (404).
Similar results were published by Tomazini et al. (405) in a Brazilian multicenter, randomized, open-label, clinical trial involving 299 adults with moderate or severe ARDS due to COVID-19. The study showed that 144 patients who received dexamethasone treatment plus the standard treatment showed a significant increase in the number of days without mechanical ventilation during the first 28 days. In the same way, Villar et al. (406) also published a multicenter randomized clinical trial and showed that early administration of dexamethasone in COVID-19 patients who had moderate and severe ARDS presented an increased average number of days without mechanical ventilation, as well as reduced mortality compared to the control group. There are currently 29 clinical trials evaluating the therapeutic efficacy of dexamethasone in COVID-19 patients.
In the face of the huge amount of studies involving clinical trials to test drugs for SARS-CoV-2 and COVID-19 treatment, in addition to the different research methodologies and criteria addressed, on March 22, 2020 the WHO and partners launched the “SOLIDARITY”, an international clinical trial. The purpose is to help find an effective treatment for COVID-19, seeking to establish consistent endpoints, control arms, and inclusion-exclusion criteria for this umbrella trial (13).
The SOLIDARITY trial includes hospitalized patients with COVID-19 from more than 90 countries around the world to compare treatment options with standard care and assess their relative effectiveness against SARS-CoV-2. By enrolling patients from multiple countries, the SOLIDARITY trial aims at rapidly discovering if any of the drugs mitigate disease progression or improve survival. According to the WHO director-general, the study will dramatically cut the time needed to generate robust evidence on how the drugs work. Thus, the two most promising treatment options selected were Remdesivir or Lopinavir/Ritonavir with IFN-β. Other drugs can be added based on emerging evidence (13).