Results from Oxford University’s RECOVERY trial into existing drugs for the treatment of COVID-19 has found that dexamethasone reduced deaths by a third in ventilated coronavirus patients and by a fifth in coronavirus patients requiring oxygen. This is the first drug of its kind to demonstrate a significant impact on COVID-19 mortality.
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The Randomised Evaluation of COVID-19 Therapy trial (RECOVERY) is a randomised clinical trial of over 11,500 patients across 175 NHS hospitals in the UK. The trial is testing a range of established and promising treatments including: lopinavir-ritonavir, low-dose dexamethasone (a type of steroid, which typically used to reduce inflammation), hydroxychloroquine (since stopped due to lack of efficacy), azithromycin, tocilizumab and convalescent plasma, containing SARS-CoV-2 antibodies collected from recovered COVID-19 donors.
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Results released on June 16th 2020, explained that low dose dexamethasone was administered to 2,104 experimental patients daily (6 mg intravenously or orally) for 10 days, which were compared with the results of 4,321 patients who received usual care. Patients were separated based on the severity of the care required, ranging from not receiving respiratory intervention (13%), requiring oxygen (25%) or full ventilation (41%).
The results showed that there was no significant difference for patients who required no respiratory intervention, but for those who received oxygen there was a one fifth reduction in mortality rate, and a one third reduction in mortality for ventilated patients. This represents a 17% reduction in 28 day mortality rate.
Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone.”
Lead researcher Prof Martin Landray
This is the only drug so far that has been shown to reduce mortality - and it reduces it significantly. It's a major breakthrough."
Chief investigator Prof Peter Horby
Dexamethasone is a synthetic adrenal corticosteroid with potent anti-inflammatory properties. In addition to binding to specific nuclear steroid receptors, dexamethasone also interferes with NF-kB activation and apoptotic pathways. This agent lacks the salt-retaining properties of other related adrenal hormones. (NCI04).
Dexamethasone is not expensive, and is widely available. "There is a clear, clear benefit. The treatment is up to 10 days of dexamethasone and it costs about £5 per patient. So essentially it costs £35 to save a life. This is a drug that is globally available." However the authors have cautioned against the public going out to buy the drug.
Reactions to the news has been extremely positive so far with England's chief medical officer commenting the following:
This is the most important trial result for COVID-19 so far. Significant 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."
Professor Chris Whitty, Chief Medical Officer, England
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