Dexamethasone, Remdesivir Lowers Risk for COVID-19 Neurological Complications

Patients hospitalized with COVID-19 who received dexamethasone and/or remdesivir had fewer neurological complications than patients who did not, according to study findings published in the Annals of Neurology.

A range of multi-system complications have been observed among patients with COVID-19, including neurological manifestations. Risk for neurological outcomes have been linked with more severe and longer-lasting disease. As dexamethasone and remdesivir have been found to reduce severity risk and time to recovery in COVID-19, this study was designed to evaluate whether the beneficial effects of dexamethasone and remdesivir extend to neurological outcomes.

Researchers from the United Kingdom (UK) sourced data for this analysis from the International Severe Acute and emerging Respiratory Infection Consortium (ISARIC) World Health Organization (WHO) Clinical Characterization Protocol UK (CCP-UK) study. Neurological outcomes were evaluated among inpatients (N=89,297) admitted to the hospital between January 2020 and June 2021 with COVID-19 on the basis of receiving dexamethasone and/or remdesivir using a propensity score matching strategy.

The study population had severe COVID-19 (n=64,088) and non-hypoxic COVID-19 (n=25,209).

These are the characteristics of individuals in the severe and non-hypoxic cohorts, respectively:

• Patients mean age, 70 (interquartile range [IQR], 56-81) and 72 (IQR, 54-83) years
• 59% and 50% were men
• 72% and 72% were White
• Comorbidity scores were 2 (IQR, 1-3) and 2 (IQR, 1-3)
• Clinical Frailty Scores were 4 (IQR, 2-6) and 4 (IQR, 3-6)
• 30% and 0% were ventilated
• 21% and 0.9% were admitted to the intensive care unit (ICU)
• Mortality rates were 32% and 9.2%
• Neurological complications were observed among 4.8% and 4.5% of patients

The patients received usual care (n=30,685), dexamethasone (n=21,129), remdesivir (n=1428), remdesivir from day 1 (n=354), both dexamethasone and remdesivir (n=10,846), and dexamethasone and remdesivir from day 1 (n=2737).

Among patients with severe COVID-19 who had neurological complications, risk for mortality was decreased among patients who received dexamethasone (adjusted odds ratio [aOR], 0.86), both dexamethasone and remdesivir (aOR, 0.67), and both dexamethasone and remdesivir from day 1 (aOR, 0.53) compared with usual care.

Among the whole severe COVID-19 cohort, receiving dexamethasone and/or remdesivir was associated with decreased risk for seizure (odds ratio [OR] range, 0.28-0.41), stroke (OR range, 0.40-0.57), and meningitis or encephalitis (OR, 0.13-0.42) in general, expect that remdesivir from day one and remdesivir alone were not significantly associated with stroke or meningitis or encephalitis risk, respectively. Risk for other neurological complications was decreased among dexamethasone and remdesivir recipients (OR range, 0.54-0.64).

In non-hypoxic COVID-19, risk for stroke was significantly lower among dexamethasone recipients (OR, 0.47; 95% CI, 0.29-0.72).

The data used for this study may not have been complete, due to the inherent challenges of collecting patient data while providing care early in the COVID-19 pandemic.

The researchers concluded, “We have shown that neurological complications result in significant mortality and morbidity from COVID-19, and a significantly lower frequency of these events was seen in association with dexamethasone and/or remdesivir treatment. This is of great importance to individual patients, healthcare systems and public health bodies, although further studies are required to establish causality.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.