On June 17, Beijing time, a news report in the international top academic journal Nature reported that the British RECOVERY trial has found that a cheap and commonly used steroid can save the lives of severely ill patients with COVID-19.
The drug, dexamethasone, is the first to be shown to reduce deaths in coVID-19 patients.
In the trial, dexamethasone reduced coVID-19 deaths by about a third.
“This is a stunning result,” said Kenneth Baillie, an intensive care doctor at the University of Edinburgh in the United Kingdom. The experiment is called RECOVERY.
“This is obviously going to have a huge global impact.”
The RECOVERY trial, launched in March, is one of the largest randomized controlled trials of coronavirus treatment in the world.
The study recruited 2,100 participants who received a low or moderate dose of dexamethasone of 6 mg daily for 10 days and compared them with about 4,300 people who received routine care for coronavirus infection.
Dexamethasone was most effective in critically ill patients on ventilators.
Those on oxygen therapy but not on a ventilator also improved: these participants had a 20 percent lower risk of death.
In mild coVID-19 cases (those not receiving oxygen or ventilation), steroids had no effect on outcome.
“This is a major breakthrough,” said Peter Horby, an infectious disease specialist at the University of Oxford in the United Kingdom and lead researcher on the trial.
Horby noted that steroid use for viral respiratory infections such as COVID-19 has been controversial.
He said data from steroid trials during related outbreaks of SARS and MERS caused by coronaviruses were inconclusive.
Still, given the widespread use of dexamethasone and some encouraging results from previous steroid studies in outbreaks, Horby said RECOVERY researchers felt it was important to test the treatment in rigorous clinical trials.
Image source: Nature
Treatment guidelines from the World Health Organization and many countries have cautioned against steroid treatment for patients with coronavirus, and some researchers have expressed concern about anecdotal reports of widespread steroid treatment.
These drugs suppress the immune system, which can help patients with lung damage recover.
But these patients may still need a fully functioning immune system to fend off the virus itself.
The RECOVERY trial suggests that at the dose tested, the benefits of steroid treatment may outweigh the potential harm.
The study did not find significant adverse events associated with the treatment, the researchers said.
“Almost anyone can get this treatment,” Horby says.
The team aims to publish its results quickly and share their findings with UK and international regulators, he said.
“Finding effective treatments will change the impact of the COVID-19 pandemic on lives and economies around the world,” said Cammack at biomedical research charity WellcomeNick in London, UK.
“Although this study shows that dexamethasone benefits only those with severe illness, it will save countless lives worldwide.”
To date, in a large, randomized, controlled clinical trial, the only drug that has shown benefit for coVID-19 patients has been the antiviral drug Reddecyvir.
Although reddicivir was shown to shorten the time a patient might spend in hospital, it had no statistically significant effect on death.
Rydesivir is also in short supply.
While Gilead Sciences, the drug’s maker, has taken steps to increase production of Reddisivir, it is currently only used in a limited number of hospitals around the world.
The way reddisivir is administered is complex: it must be given by injection over a period of several days.
Dexamethasone, by contrast, is a medical drug available on drug shelves around the world.
Martin Landray, an epidemiologist at the University of Oxford and another lead investigator in the RECOVERY trial, said: “For less than £50, you can treat eight patients and save one life.”