Dexamethasone reduces death in hospitalised patients with severe respiratory complications of COVID-19
In March 2020, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial was established as a randomised clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). More than 11,500 patients have been registered in over 175 NHS hospitals in the UK.
Dexamethasone
On June 8, recruitment was halted because, in the opinion of the trial steering committee, sufficient patients had been recruited to determine whether or not dexamethasone had a significant benefit.
A total of 2104 patients were randomized to receive 6 mg of dexamethasone once daily (oral or intravenous) for ten days and compared to 4321 patients randomized to receive usual care only. Among patients who received usual care alone, mortality at 28 days was highest among those who required ventilation (41%), intermediate among those who required oxygen only (25%), and lowest among those who did not require respiratory intervention (13%).
Dexamethasone reduced deaths by one-third in ventilated patients and by one-fifth in other patients receiving oxygen alone. There was no benefit in patients who did not require respiratory assistance. Based on these results, one death would be prevented by this treatment of about 8 ventilated patients or about 25 patients requiring only oxygen. Given the public health importance of these results, researchers are now working to publish the full details as soon as possible.
It improves survival
Peter Horby, Professor of Emerging Infectious Diseases at the Nuffield Department of Medicine, Oxford University, and one of the lead investigators of the trial, said: "Dexamethasone is the first drug to be shown to improve survival in patients with VIDOC-19. This is an extremely pleasing result. The survival benefit is clear and significant in patients who are ill enough to require oxygen therapy, so dexamethasone should now become the standard of care in these patients. Dexamethasone is inexpensive, over-the-counter, and can be used immediately to save lives around the world.
Martin Landray, Professor of Medicine and Epidemiology at the Nuffield Department of Population Health at Oxford University, one of the lead researchers, said: "Since the appearance of COVID-19 six months ago, there has been a search for treatments that could improve survival, especially in the sickest patients. The preliminary results of the RECOVERY trial are very clear: dexamethasone reduces the risk of death in patients with severe respiratory complications. COVID-19 is a global disease - it's fantastic that the first treatment proven to reduce mortality is instantly available and affordable around the world.
An inexpensive drug
The Chief Scientific Adviser to the UK Government, Sir Patrick Vallance, said: "This is excellent news today, with the Recovery trial showing that dexamethasone is the first drug to reduce mortality from COVID-19. This is particularly interesting because it is an inexpensive and widely available drug. This is a revolutionary advance in our fight against this disease, and the speed at which researchers have made progress in finding an effective treatment is truly remarkable. This shows the importance of conducting high-quality clinical trials and basing decisions on the results of these trials.
