Potential positive news has come during the COVID-19 pandemic. Researchers in the United Kingdom have suggested that the corticosteroid medication dexamethasone could save lives among the severely affected.
The National Institute for Health Research (NIRH) reports that a “study, conducted at the University of Oxford and led by Professor Peter Horby and Professor Martin Landray, found that dexamethasone reduced the risk of dying by one-third in ventilated patients and by one fifth in other patients receiving oxygen only. There was no benefit among those who did not need respiratory intervention.” The NIRH co-funds and supports the Randomised Evaluation of COVid-19 thERapY (RECOVERY) trial which is investigating various therapies for COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or simply coronavirus.
RECOVERY explains that “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 percent), intermediate in those patients who required oxygen only (25 percent), and lowest among those who did not require any respiratory intervention (thirteen percent).
“Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95 percent confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75; p=0.14). Based on these results, one death would be prevented by treatment of around eight ventilated patients or around 25 patients requiring oxygen alone.”
“This is the most important trial result for COVID-19 so far,” Professor Chris Whitty, the Chief Medical Officer for England and a leading figure in the UK government’s COVID-19 response, tweeted. “Significiant [sic] reduction in mortality in those requiring oxygen or ventilation from a widely available, safe and well known drug. Many thanks to those who took part and made it happen. It will save lives around the world.”
Landray touted the result, stating “this…shows that if patients who have COVID-19 and are on ventilators or are on oxygen are given dexamethasone, it will save lives, and it will do so at a remarkably low cost. It’s going to be very hard for any drug really to replace this, given that for less than £50 (US$63.26), you can treat eight patients and save a life.”
Some have urged caution. “It will be great news if dexamethasone, a cheap steroid, really does cut deaths by 1/3 in ventilated patients with COVID19, but after all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper,” tweeted Atul Gawande, MD, MPH, a surgeon and chairman of Haven Healthcare. Hydroxychloroquine, for example, was the subject of a controversial study published in The Lancet which was subsequently retracted.
