A large-scale clinical trial in the United Kingdom has shown that the steroid dexamethasone decreases the rate of death in COVID-19 patients requiring oxygen, although the drug has no effect on patients that do not require respiratory support.
The randomized trial was conducted on 2,104 patients who were given a low dose (6mg) of dexamethasone once a day, orally or by intravenous injection, for 10 days. The results were compared with 4,321 patients who received standard care.
The mortality rate for patients receiving standard care was 41% with ventilation and 25% in patients receiving oxygen only. The death rate for patients that were not given respiratory support was 13%.
The results of the trial are preliminary and have not yet been published in a peer-reviewed journal, but they show that there was a significant reduction in the COVID-19 death rate. The mortality rate was reduced by up to a third for ventilated patients and a 20% for patients receiving oxygen. The researchers conducting the Randomized Evaluation of COVid-19 thERapy trial suggest dexamethasone can prevent one death in eight ventilated patients or around 25 patients receiving oxygen.
Overall, dexamethasone reduced the 28-day mortality rate by 17% with the greatest benefit for ventilated patients, but no benefit at all for patients not requiring oxygen.
“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,” said 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. Dexamethasone is also widely available and cheap, so can easily be provided to patients immediately in hospitals around the world.
Dexamethasone was one of several potential treatments for COVID-19 that were tested in the trial, the others being the HIV drug Lopinavir-Ritonavir, the antibiotic azithromycin, the anti-inflammatory Tocilizumab, and convalescent plasma collected from donors who have recovered from COVID-19. Hydroxychloroquine was also tested but the trial was stopped due to a lack of efficacy Follow-ups have now been completed for 94% of patients.
You can read more about the results of the trial here.