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Steroid reduces Covid-19 deaths up to a third, shows UK trial
The study involved 2,104 patients who were randomly given dexamethasone and their recovery was compared with 4,321 patients getting only usual care.
A cheap and easily available steroid has proven to reduce deaths by up to one third in severely ill patients with the Covid-19, according to a trial in the United Kingdom that now offers one of the strongest hopes of tackling a disease that has claimed more than 430,000 lives this year.
The results – described as a major breakthrough by the researchers -- were released on Tuesday by the University of Oxford. The study involved 2,104 patients who were randomly given dexamethasone and their recovery was compared with 4,321 patients getting only usual care.
“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 inexpensive, on the shelf, and can be used immediately to save lives worldwide,” he added.
The results were described by experts such as the UK government’s chief scientific adviser Patrick Vallance as “ground-breaking” and came on a day the Imperial College London announced it will begin its human trial for a vaccine from this week.
Oxford said that it began the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial in March to test a range of potential treatments for Covid-19, including low-dose dexamethasone. Over 11,500 patients have been enrolled from over 175 hospitals in the UK. The trial also recently found that hydroxychloroquine did not lead to any significant benefits.
A total of 2,104 patients randomly received 6 mg of the drug once a day (either by mouth or by intravenous injection) for ten days and were compared with 4,321 patients randomised to usual care alone.
Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).
Dexamethasone reduced deaths by one-third in ventilated patients, and by one fifth in other patients receiving oxygen only, the researchers said in their statement. More details about the results were to be published soon, they added.
“Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone,” the university added.
Experts in India agreed the finding represented a significant breakthrough. “Along with remdesivir, this is the most significant therapy for Covid-19. The Oxford study is a large study, as over 2,000 patients were randomised to receive dexamethasone, which reduced deaths by one-third in pressurised ventilated patients and by a fifth in patients receiving oxygen only. It did not benefit patients with mild disease without respiratory support,” said Dr Nirmal K Ganguly, former director general, Indian Council of Medical Research (ICMR).
The development is particularly significant because it is cheap and widely available in India. “It costs a few rupees, and is the standard of care to treat septicaemia for decades,” he said, adding that it was being used in India to treat septic shock in Covid-19 patients, an advanced stage condition when patients register a sudden blood pressure drop and fluid blood vessels develop leaks, which leads to death. “In this trial, it was given to ventilated patients and patients on oxygen before they went into septic shock, which prevented death,” he added.
“But I want to caution people not to have it without medical supervision as it belongs to the cortisone family, which are steroids used to lower inflammation,” the former ICMR head said.
American surgeon and public health researcher Atul Gawande said the findings were welcomed but urged that people wait for the trial results to be published in full. “It will be great news if dexamethasone, a cheap steroid, really does cut deaths by 1/3 in ventilated patients with COVID19, but after all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper,” he said in a post on Twitter on Tuesday.
