Existing and affordable steroid treatment reduces mortality in hospitalized COVID-19 patients

June 2020 Corona Willem van Altena


An anti-inflammatory drug, dexamethasone, is the first drug shown to help save severely ill coronavirus patients, according to scientists in Great Britain. Researchers from Oxford University came with this news last week, even before a peer-reviewed article had been published in a scientific magazine.

According to their findings, dexamethasone reduced mortality in COVID-19 patients on respirators by a third, and by a quarter in hospitalized patients who were only receiving extra oxygen. Given the public health importance of these results, the researchers are now working to publish the full details as soon as possible.

RECOVERY

The discovery is a result from the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial, In this large-scale randomised clinical trial, several existing medicines are tested for their efficacy against COVID-19. In total, more than 11,500 patients have been enrolled from over 175 NHS hospitals in the UK.

In the dexamethasone arm of the trial, a total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).

Reduced death

Dexamethasone, an anti-inflammatory steroid-based drug used for a wide array of indications, reduced deaths by one-third in ventilated patients (RR 0.65 [95% CI 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (RR 0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (RR 1.22 [0.86 to 1.75; p=0.14). The drug was also not studied in patients outside of the hospital.

“Dexamethasone is the first drug to be shown to improve survival in Covid-19,” one of the trial’s chief investigators, Peter Horby, a professor of emerging infectious diseases at the University of Oxford, says in a statement from Oxford University. “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment.” Dr. Horby adds that dexamethasone should now become the “standard of care in these patients. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”

Hydroxychloroquine

In the RECOVERY trial, dexamethasone is not the only drug whose possible corona-fighting abilities are being examined. The trial also focuses on antibiotics, anti-HIV therapies and convalescent plasma. The malaria medicine hydroxychloroquine, that has been the subject of recent controversy, has also been included in the RECOVERY trial, but that research has been cancelled now that it has become apparent that there are no significant benefits compared to the standard treatment.

References

Read the full statement by Oxford University

Read more about the RECOVERY trial

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