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Intranasal Versus Intravenous Dexamethasone to Treat Hospitalized COVID-19 Patients: A Randomized Multicenter Clinical Trial

2024; Elsevier BV; Volume: 55; Issue: 2 Linguagem: Inglês

10.1016/j.arcmed.2024.102960

1873-5487

Graciela Cárdenas, María Chávez‐Canales, Ana Marı́a Espinosa, Antonio Jordán‐Ríos, Daniel Anica Malagon, Manlio F. Márquez, Laura Victoria Torres Araujo, Ricardo Leopoldo Barajas Campos, Rosa María Wong‐Chew, Luis Esteban Ramírez González, Karent Ibet Cresencio, Enrique García Velázquez, Mariana Rodriguez de la Cerda, Yoana Leyva-López, Joselín Hernández-Ruiz, María Luisa Hernández-Medel, Mireya León-Hernández, Karen Medina‐Quero, Anahí Sánchez-Monciváis, Eduardo Beltrán Sarmiento, Rafael Ignacio Aguilar Reynoso, Daniela Murillo Reyes, Luis Rodrigo del Río Ambriz, Juan Salvador García Hernández, Jocelyn Cruz, Sergio Iván Valdés‐Ferrer, Leonor Huerta, Nora A. Fierro, Marisela Hernández, Mayra Pérez-Tapia, Gabriela Meneses, Gabriela Rosas-Salgado, Juan Alberto Hernández-Aceves, Jaquelynne Cervantes-Torres, Ricardo A. Valdez, Anai Fuentes Rodríguez, Erick Espíndola-Arriaga, Mauricio Ortiz, Evelyn Alvarez Salazar, Carlos Castellanos Barba, Hugo O. Besedovsky, Marta C. Romano, Helgi Jung, Raúl J. Bobes, Gloria Soldevila, Juan Carlos López-Alvarenga, Gladis Fragoso, Juan Pedro Laclette, Edda Sciutto,

SARS-CoV-2 and COVID-19 Research

SARS-CoV2 induces flu-like symptoms that can rapidly progress to severe acute lung injury and even death. The virus also invades the central nervous system (CNS), causing neuroinflammation and death from central failure. Intravenous (IV) or oral dexamethasone (DXM) reduced 28 d mortality in patients who required supplemental oxygen compared to those who received conventional care alone. Through these routes, DMX fails to reach therapeutic levels in the CNS. In contrast, the intranasal (IN) route produces therapeutic levels of DXM in the CNS, even at low doses, with similar systemic bioavailability. To compare IN vs. IV DXM treatment in hospitalized patients with COVID-19. A controlled, multicenter, open-label trial. Patients with COVID-19 (69) were randomly assigned to receive IN-DXM (0.12 mg/kg for three days, followed by 0.6 mg/kg for up to seven days) or IV-DXM (6 mg/d for 10 d). The primary outcome was clinical improvement, as defined by the National Early Warning Score (NEWS) ordinal scale. The secondary outcome was death at 28 d between IV and IN patients. Effects of both treatments on biochemical and immunoinflammatory profiles were also recorded. Initially, no significant differences in clinical severity, biometrics, and immunoinflammatory parameters were found between both groups. The NEWS-2 score was reduced, in 23 IN-DXM treated patients, with no significant variations in the 46 IV-DXM treated ones. Ten IV-DXM-treated patients and only one IN-DXM patient died. IN-DMX reduced NEWS-2 and mortality more efficiently than IV-DXM, suggesting that IN is a more efficient route of DXM administration.