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June 16, 2020

Inexpensive steroid reduces death risk among severe COVID-19 patients

Dexamethasone has clear 'survival benefit,' Oxford study finds

A cheap and widely available steroid could be a vital tool to limit the death toll among COVID-19 patients hospitalized with severe respiratory complications, according to researchers at the University of Oxford.

The corticosteroid medicine dexamethasone, used to treat a variety of conditions, was administered to 2,104 patients as part of a larger series of clinical trials testing the effectiveness of various treatments. Patients received the drug either orally or intravenously for 10 days.

After a 28-day period, researchers compared the outcomes of the dexamethasone patients to 4,321 patients who received only usual care.

The steroid reduced deaths by 35% among patients on breathing machines and by 20% among patients who only needed supplemental oxygen. There was no benefit to patients who did not require respiratory support.

Peter Horby, chief investigator of the Oxford trial, called the findings 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," Horby said. "Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide."

The results come as part of England's wider RECOVERY trial, which tested several COVID-19 treatments on 11,500 patients who enrolled through the National Health Service. The same trial determined that the malaria drug hydroxychloroquine was not useful against the coronavirus. In the United States, the Food and Drug Administration revoked emergency use of hydroxychloroquine on Monday.

Steroids like dexamethasone work by reducing inflammation, in this case by calming an overactive immune response that sometimes proves fatal in COVID-19 patients.

The World Health Organization has advised against using steroids earlier in the course of COVID-19 because the drugs could stall the body's ability to clear the virus.

Based on the results of the dexomethasone trial, researchers said the steroid would prevent one death among every eight ventilated patients. It also would prevent one death for every 25 patients requiring oxygen alone. 

"The search has been on for treatments that can improve survival, particularly in the sickest patients," said Martin Landray, another chief investigator at Oxford. "These preliminary results from the RECOVERY trial are very clear – dexamethasone reduces the risk of death among patients with severe respiratory complications. COVID-19 is a global disease – it is fantastic that the first treatment demonstrated to reduce mortality is one that is instantly available and affordable worldwide."

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