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Preliminary results about low-cost dexamethasone use, promising for COVID-19 patients

Dexamethasone, a low-cost steroid-hormone drug has been used since the 1960s to reduce inflammation in a range of conditions, including inflammatory disorders and certain cancers. It is often used by athletes to treat pain has been found to be a life-saving treatment for coronavirus patients by Oxford University’s Recovery Trial.

In a statement by the RECOVERY trial—the world’s largest combined effort to find treatments for COVID-19—Chief Investigator Martin Landray says that preliminary results from the trial “are very clear—dexamethasone reduces the risk of death among patients with severe respiratory complications.”

Of the over 11,500 patients enrolled in the RECOVERY trial, 2,104 were randomised to receive 6mg of dexamethasone once a day (either by mouth or by intravenous injection) for ten days—and this was compared to 4,321 patients randomised to usual care alone.

Noting that among usual-care patients, 28-day mortality was highest among those who required ventilation, the statement says that Dexamethasone reduced deaths by one-third in ventilated patients and by one-fifth in other patients receiving oxygen only. There was no benefit among patients who did not require respiratory support.

Overall dexamethasone reduced the 28-day mortality rate by 17% (0.83 [0.74 to 0.92]; P=0.0007) with a highly significant trend showing greatest benefit among those patients requiring ventilation (test for trend p<0.001). But it is important to recognise that we found no evidence of benefit for patients who did not require oxygen and we did not study patients outside the hospital setting.

Peter Horby, Professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, and one of the Chief Investigators for the trial, said, “Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result. The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”

Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone.

The World Health Organization (WHO) welcomed the initial clinical trial results from the United Kingdom (UK) that show dexamethasone, a corticosteroid, can be lifesaving for patients who are critically ill with COVID-19. For patients on ventilators, the treatment was shown to reduce mortality by about one third, and for patients requiring only oxygen, mortality was cut by about one fifth, according to preliminary findings shared with WHO.

“This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This is great news and I congratulate the Government of the UK, the University of Oxford, and the many hospitals and patients in the UK who have contributed to this lifesaving scientific breakthrough.”

WHO will coordinate a meta-analysis to increase our overall understanding of this intervention. WHO clinical guidance will be updated to reflect how and when the drug should be used in COVID-19.

The findings reinforce the importance of large randomized control trials that produce actionable evidence. WHO will continue to work together with all partners to further develop lifesaving therapeutics and vaccines to tackle COVID-19 including under the umbrella of the Access to COVID-19 Tools Accelerator.

MB Bureau