Steroid first drug to save lives in Covid-19 fight, initial results show

A cheap and widely used steroid called dexamethasone has become the first drug shown to be able to save lives among Covid-19 patients in what scientists said is a "major breakthrough" in the coronavirus pandemic.

Trial results announced on Tuesday showed dexamethasone, which is used to reduce inflammation in other diseases such as arthritis, reduced death rates by around a third among the most severely ill of Covid-19 patients admitted to the hospital.

Researchers led by a team from the University of Oxford administered the widely available drug to more than 2,000 severely ill Covid-19 patients.

Normally used to treat a range of allergic reactions as well as rheumatoid arthritis and asthma, dexamethasone is an anti-inflammatory.

Daily doses of the steroid could prevent one-in-eight ventilated patient deaths and save one out of every 25 patients requiring oxygen alone, the team said.

Reducing the mortality rate

"This is a (trial) result that shows that if patients who have Covid-19 and are on ventilators or are on oxygen are given dexamethasone, it will save lives, and it will do so at a remarkably low cost," said Martin Landray, an Oxford University professor co-leading the trial, known as the RECOVERY trial. 

"It's going to be very hard for any drug really to replace this, given that for less than 50 pounds ($63.26), you can treat eight patients and save a life," he said in an online briefing.

His co-lead investigator, Peter Horby, said dexamethasone was "the only drug that's so far shown to reduce mortality ⁠— and it reduces it significantly."

"It is a major breakthrough," he said. "Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide."

Save Lives Around the World

England's chief medical officer, Chris Whitty, said Tuesday's announcement was "the most important trial result for Covid-19 so far," adding, "It will save lives around the world."

The RECOVERY trial compared outcomes of around 2,100 patients who were randomly assigned to get the steroid, with those of around 4,300 patients who did not get it.

The results suggest that one death would be prevented by treatment with dexamethasone among every eight ventilated Covid-19 patients, Landray said, and one death would be prevented among every 25 Covid-19 patients that received the drug and are on oxygen.

Among patients with Covid-19 who did not require respiratory support, there was no benefit from treatment with dexamethasone.

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," Horby said. 

'Remarkable' potential

The trial results are particularly promising as around 40 percent of Covid-19 patients who require a ventilator end up dying, often because of the body's uncontrolled inflammatory response to the virus.

For those receiving the new treatment, the mortality rate dropped to less than 30 percent.

"This is a major breakthrough: dexamethasone is the first and only drug that has made a significant difference to patient mortality for Covid-19," said Nick Cammack, Covid-19 therapeutics accelerator lead at the Wellcome Trust health charity.

UK patients to receive it immediately

Britain's Health Secretary Matt Hancock said the country's patients would start to receive the drug immediately.

Hancock said the government had started stockpiling dexamethasone back in March after preliminary trials showed "early signs" of the drug's potential.

The RECOVERY trial was launched in April as a randomised clinical trial to test a range of potential treatments for Covid-19, including low-dose dexamethasone and the malaria drug hydroxychloroquine.

The hydroxychloroquine arm was halted earlier this month after Horby and Landray said results showed it was "useless" at treating Covid-19 patients.

There are currently no approved treatments or vaccines for Covid-19, the disease caused by the new coronavirus, which has killed more than 431,000 people globally.

Other trials of treatment of the novel coronavirus

A number of existing drugs have been trialled as a treatment against the novel coronavirus, with mixed results.

Trials of treatment of the anti-arthritis drug hydroxychloroquine were halted in several countries after a major study in The Lancet medical journal suggested it showed no benefit among Covid-19 patients and even increased the risk of death.

That study has since been retracted due to inconsistencies in the data, but others have come to the same conclusion.

Remdesivir, an anti-viral that appears to reduce the length of treatment in some patients, is already being used in Britain, but one study in April showed it had "no significant clinical benefit."

The fact that an existing, cheap and largely side-effect free medication has been shown to be effective in severe Covid-19 cases is "of tremendous importance," according to Stephen Griffin, associate professor in the School of Medicine, University of Leeds.

"There is (now) realistic scope for further improving the clinical management of this devastating disease," said Griffin, who was not involved in the study.

Cammack said that in light of the study results, dexamethasone "must now be rolled out and accessed by thousands of critically ill patients around the world."

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