The cheap and widely available drug dexamethasone can be used to help save the lives of the sickest Covid-19 patients, according to experts in the UK. Findings are still preliminary and yet to be published in a peer-reviewed journal, but experts from around the world are regarding the results as a major breakthrough.
The low-dose steroid treatment dexamethasone is part of the Recovery Trial, the world’s biggest trial testing the efficacy of existing treatments in the fight against Covid-19. Experts hope that the drug can be used to save the lives of many of the sickest coronavirus patients around the world who require the use of ventilation or oxygen.
The Recovery Trial has so far found that the low-dose administration of dexamethasone over 10 days cuts the risk of death for patients on ventilators by a third and for those requiring the help of oxygen, it cut deaths by around a fifth.
“That’s a highly statistically significant result,” Martin Landray, deputy chief investigator of the trial and a professor at the University of Oxford, said during a virtual press conference this week.
“This is a completely compelling result. If one looks at the patients who did not require ventilators but were on oxygen, there was also a significant risk reduction of about one-fifth,” Landray added. “However, we didn’t see any benefit in those patients who were in hospital, had Covid, but whose lungs were working sufficiently well – they were not taking either oxygen or on ventilators.”
“We have not studied patients in the community,” Landray said. “We show no effect in the patients who are not on oxygen and we did not study the patients who are not in hospital.”
Researchers have said that if the drug had been used since the start of the pandemic, up to 5,000 lives could have been saved in the UK alone. The findings give fresh hopes to poorer countries that are still in the midst of a heavy battle with Covid-19, with experts suggesting the drug could save many, many lives around the world in the foreseeable future.
“At this stage, we found no clear adverse effects of doing this. Let’s recognize that there are sort of two messages here. In the people who required oxygen or ventilation, it clearly works, and the benefits are biggest for those on ventilators. In the people in hospital with Covid who do not require oxygen – so, their lungs are working moderately well – then actually there’s no benefit,” Landray said on Tuesday.
“In the trial, our focus was on mortality, which obviously a drug can affect in either direction, but the overall results in the patients on oxygen and ventilation was a clear, clear benefit,” Landray said, adding that deaths in the study were examined over a 28-day period. “We’ve looked, for example, were there deaths due to other forms of infection, which are sometimes considered a risk? And the answer is no, there was no excess of any other particular cause of death.”
The Recovery Trial’s dexamethasone trial ended last week, and the researchers are now in the process of compiling its data. The study included around 2,000 hospitalized Covid-19 sufferers who were randomly selected to receive dexamethasone as a treatment, as well as over 4,000 other hospitalized patients who received the usual care.
A dose of 6mg of dexamethasone was given to the chosen patients once a day for up to 10 days, either administered as an injection or taken orally. Results are of course as yet only preliminary, but the researchers reported that there were no serious adverse events among the patients who were administered dexamethasone.
“The first drug proven to cut deaths from Covid-19 is not some new, expensive medicine but an old, cheap-as-chips steroid. That is something to celebrate because it means patients across the world could benefit immediately,” health expert Fergus Walsh told the BBC.
“And that is why the top-line results of this trial have been rushed out – because the implications are so huge globally. Dexamethasone has been used since the early 1960s to treat a wide range of conditions, such as rheumatoid arthritis and asthma.
“Half of all Covid patients who require a ventilator do not survive, so cutting that risk by a third would have a huge impact. The drug is given intravenously in intensive care and in tablet form for less seriously ill patients.
“So far, the only other drug proven to benefit Covid patients is remdesivir, which has been used for Ebola.
“That has been shown to reduce the duration of coronavirus symptoms from 15 days to 11. But the evidence was not strong enough to show whether it reduced mortality. Unlike dexamethasone, remdesivir is a new drug with limited supplies and a price has yet to be announced.