Dexamethasone and Remdesivir reduces post COVID Neurological Complications

COVID-19 is associated with a range of multi-system complications including neurological disorders. Remdesivir is a repurposed antiviral medication that has shown broad antiviral action in vitro against emerging coronaviruses, including MERS-CoV, SARS-CoV-1 and SARS-CoV-2. Remdesivir was shown to reduce the time to clinical improvement in a separate retrospective analysis of hospitalised COVID-19 patients. Dexamethasone is now a widely used treatment for COVID-19 after clinical trials reported a reduction in 28-day mortality in hospitalised COVID-19 patients receiving either invasive ventilation or supplemental oxygen. It was also established that remdesivir, dexamethasone or both, in addition to standard of care, was associated with a reduction in the incidence of neurological complications in adults admitted to hospital with COVID-19.

COVID-19 neurological complications, and remdesivir and dexamethasone use, were studied in adults admitted to hospitals with COVID-19, using data from the International Severe Acute and emerging Respiratory Infection Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK, study registration ISRCTN66726260). 89,297 patients aged 18 years and older with laboratory-confirmed SARS-CoV-2 infection were eligible for inclusion. Patients were excluded if they received a dose of any SARS-CoV-2 vaccine or contracted COVID-19 in the hospital.  The results demonstrated that treatment with dexamethasone, remdesivir in severe COVID-19 was associated with a reduced incidence of neurological complications. . Combined treatment was associated with a larger reduction in keeping with an additive effect. It was also found that treatment with dexamethasone reduced neurological complications in non-hypoxic patients, while combined treatment with dexamethasone and remdesivir trended towards a reduced incidence.

Thus, treatment with dexamethasone, remdesivir or both in patients hospitalised with COVID-19 was associated with reduced neurological complications in an additive manner, such that the greatest benefit was observed in patients who received both drugs together. The potential of these treatments to reduce neurological disability is of urgent importance to patients, healthcare systems and public health bodies.