This Clinical Trial evaluates nasal administration of Dexamethasone as an adjuvant treatment strategy for non-critically ill hospitalized participants with SARS CoV-2 infection.
Approximately 30% of the admitted patients with Covid-19 require admission to the intensive
care unit for respiratory assistance, ranging from a high flow nasal cannula to invasive
ventilation. These patients are affected by respiratory dysfunctions and even dysfunction of
the brain respiratory control centers. Additionally, exacerbated inflammation leads to
endothelial and coagulation disorders that aggravate the course of the illness. No effective
therapy has yet been found to treat forms SARS-CoV-2 bass. One of the adjunctive therapeutic
alternatives addressed is the use of intravenously administered glucocorticoids (GC), aimed
at reducing exacerbated peripheral inflammation. They have been used at early stages of
infection in high doses and with controversial results. In our laboratory at the Biomedical
Research Institute from the National Autonomous University of Mexico (UNAM), we have shown
that dexamethasone, a GC (DXM) administered intranasally, reaches the central nervous system
through the olfactory nerve (alike various pathogens, including coronaviruses) and reduces
neuroinflammation more effectively than when applied intravenously. Additionally,
biodistribution studies indicate that the DXM is detectable from the first minute after its
application, both in the central nervous system and in the respiratory system. The objective
of this study is to evaluate the safety, efficacy and tolerability of dexamethasone in
patients hospitalized with SARS-CoV-2 with moderate-severe forms, with an without the
requirement of mechanic ventilation, including syndrome of acute respiratory distress or
pneumonia (as diagnosed by CAT) with alveolar / interstitial lung involvement.
Drug: IV Dexamethasone
6 mg from Day 1 to 10 after randomization
Other Name: ST
Drug: Nasal Dexamethasone
0.12 mg/kg/daily for 3 days from day 1, followed by 0.06 mg/kg/daily from day 4 to 10 after randomization.
Other Name: Nasal DXM
Inclusion Criteria:
- Positive diagnosis of SARS-CoV-2 by real-time RT-PCR in oropharyngeal sample.
- 7 days or more after the start of the infection
- Hospitalized patients with moderate to severe respiratory complications that do not
have received mechanical ventilation.
- Patients receiving standard therapy at the Hospital General de México Eduardo Liceaga.
- Signing of the informed consent form
- Patients of both sexes (non-pregnant female) 18 years of age or older will be eligible
if they have a positive diagnostic sample by RT-PCR, pneumonia confirmed by chest
imaging and oxygen saturation (SaO2) < 93% at ambient air or a ratio of the partial
pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) (PaO2: FiO2) at
300 mg Hg or less
Exclusion Criteria:
- Patients participating in another research protocol.
- Patients receiving oral or intravenous glucocorticoids
- Immunosuppressed patients (including HIV infection)
- Glaucoma patients.
- Patients with allergy to dexamethasone.
- Pregnant or lactating women
- Concomitant autoimmune diseases
- Refusal by the patient or family to participate in the study
Hospital General de Mexico Dr. Eduardo Liceaga
Mexico City, Cdmx, Mexico
Instituto Nacional de Cardiología Ignacio Chávez
Mexico City, Cdmx, Mexico
El Instituto Nacional de Neurologia Y Neurocirugia Manuel Velasco Suarez
Mexico City, Cdmx, Mexico
Edda Sciutto, PhD, Principal Investigator
Instituto de Investigaciones Biomédicas, UNAM