Low-cost Dexamethasone is First Drug to Improve COVID-19 Survival

June 16, 2020

New research from the University of Oxford found dexamethasone reduced death by one-third in severely ill patients hospitalized with COVID-19.

University of Oxford researchers found that treatment with the inexpensive steroid dexamethasone reduced death by one-third in severely ill patients hospitalized with coronavirus disease 2019 (COVID-19).

The researchers announced their findings today, June 16, 2020, and said they will be publishing them as soon as possible.

“This is an extremely welcome result,” said co-chief investigator Peter Horby, professor of emerging infectious diseases, Nuffield Department of Medicine, University of Oxford, United Kingdom, in the press release. “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.”

Researchers randomized 2104 patients to receive dexamethasone 6 mg once/day (either orally or intravenous injection) for 10 days and compared them with 4321 patients randomized to usual care only.

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.

Among the usual care cohort, 28-day mortality was highest in those who required ventilation (41%), intermediate in those who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).

Dexamethasone reduced mortality by one-third in ventilated patients (rate ratio [RR] 0.65 [95% confidence interval (CI) 0.48-0.88]; p=0.0003) and by one-fifth in those receiving oxygen only (RR 0.80 [95% CI 0.67-0.96]; p=0.0021).

There was no benefit among patients who did not require respiratory support (RR 1.22 [95% CI 0.86-1.75]; p=0.14).

The researchers also estimated that dexamethasone would prevent 1 death for every 8 ventilated patients and 1 for every 25 patients requiring oxygen only.

Enrolled patients were from the dexamethasone arm of the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial that tested a range of potential COVID-19 treatments in >11 500 patients from >175 UK hospitals. RECOVERY was established in March 2020. Recruitment to the dexamethasone arm was stopped on June 8 based on assessment of the trial Steering Committee that enough patients had been enrolled to establish whether the drug’s benefit was meaningful.

“These preliminary results from the RECOVERY 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,” said co-chief investigator Martin Landray, PhD, professor of medicine and epidemiology, Nuffield Department of Population Health, University of Oxford, in the same press release.

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