Low-cost steroid dexamethasone reduces death in hospitalized COVID-19 patients

A randomized clinical trial in the UK has shown that a low dosage of the steroid dexamethasone can reduce the chance of death by up to one-third in patients with severe COVID-19 complications, according to the Randomised Evaluation of COVID_19 Therapy (RECOVERY) study at Oxford University.

A dosage of 6 mg per day was administered to 2,104 patients, either by mouth or intravenously, for 10 days. These patients were compared to those receiving the usual care alone.

Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%). Dexamethasone reduced deaths by one-third in ventilated patients and by one-fifth in other patients receiving oxygen only. There was no benefit among those patients who did not require respiratory support.

Based on these results, one death would be prevented by treatment of about eight ventilated patients, or around 25 patients requiring oxygen alone. Peter Horby, professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, and one of the chief investigators for the trial, said in a statement:

“Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is 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. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”

Martin Landray, professor of Medicine and Epidemiology at the Nuffield Department of Population Health, University of Oxford, and one of the chief investigators, said in a statement: “These preliminary results from the 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.”

The UK’s chief scientific adviser, Sir Patrick Vallance, added: “This is a ground-breaking development in our fight against the disease, and the speed at which researchers have progressed finding an effective treatment is truly remarkable. It shows the importance of doing high quality clinical trials and basing decisions on the results of those trials.”