Researchers leading the RECOVERY clinical trial in the United Kingdom on Tuesday announced that dexamethasone, an anti-inflammatory low-cost drug, reduces death by up to one-third in hospitalised patients diagnosed with acute respiratory complications of Covid-19.
Calling it the “first drug to be shown to improve survival” in Covid-19, the researchers from Oxford University announced results of the dexamethasone arm of the trial.
As part of the randomised trial, 2,104 patients enrolled were administered with 6 mg of the drug for 10 days. The drug, researchers found, reduced deaths by one-third in ventilated patients and by one-fifth in patients receiving only oxygen.
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“Based on these results, 1 (one) death would be prevented by treatment of around 8 ventilated patients, or around 25 patients requiring oxygen alone,” the university stated.
The drug, commonly used in treatment of arthritis and immune system disorders, however, showed no benefit patients who did not require respiratory support, it stated.
Dexamethasone is a corticosteroid that reduces release of substances in the body that cause inflammation.
In India, specialists pointed out that another corticosteroid — Methylprednisolone — is being used in a few Covid-19 patients with severe symptoms.
“We have been using steroids in the Covid-19 treatment. We are not using it in the first 4-5 days, when there are mild symptoms. However, when inflammatory markers are high, or when there is oxygen requirement, we start with steroids,” Dr S Chatterjee, senior consultant (Internal Medicine) at Indraprastha Apollo Hospital, said.
Dr Chatterjee said: “In a few patients, this is being done between day five and day nine. These patients have shown improvement. However, in the initial stages of treatment, we are not using steroids. In our hospital we are using Methylprednisolone.”
The UK results are part of the RECOVERY (Randomised Evaluation of COVid-19 thERapY) — the clinical trial that began on March 2020 to examine a range of tests for potential treatment for Covid-19. “Given the public health importance of these results, we are now working to publish the full details as soon as possible,” Oxford University stated in a release.
The randomised clinical trial, which has over 11,500 patients enrolled from over 175 NHS hospitals in the UK, is testing six treatments: convalescent plasma therapy, Lopinavir-Ritonavir, commonly used to treat HIV; Tocilizumab, an anti-inflammatory treatment given by injection; Azithromycin, a commonly used antibiotic; Hydroxychloroquine, for which recruitment has already been closed; and low-dose Dexamethasone, for which recruitment has been closed to adults.
The university stated that dexamethasone was found to have reduced the 28-day mortality rate by 17 per cent, with a “highly significant” trend showing “greatest benefit” among patients requiring ventilation. “But it is important to recognise that we found no evidence of benefit for patients who did not require oxygen, and we did not study patients outside the hospital setting. Follow-up is complete for over 94% of participants,” it stated.
Peter Horby, professor of Emerging Infectious Diseases in Nuffield Department of Medicine, Oxford University, and one of the chief investigators for the trial, said: “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 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 Nuffield Department of Population Health and one of the chief investigators, said: “…These preliminary results from the RECOVERY trial are very clear -– dexamethasone reduces 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.”