Dexamethasone reduces death rate in patients with severe Covid-19 respiratory issues

The RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial was rolled out in March 2020 as a randomised clinical trial to test a range of potential treatments for Covid-19.

A low-dose dexamethasone steroid treatment was amongst the drugs trialled where on June 8, recruitment to the trial was halted since sufficient patients had been enrolled to establish whether the drug had meaningful benefit.

2104 patients were randomised to receive dexamethasone 6mg once per day by mouth or intravenous injection for ten days and were compared to 4321 patients who received usual care.

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%).

The drug reduced death by one-third in ventilated patients and by one-fifth in patients receiving oxygen alone.

No benefit was seen in patients who did not require respiratory support.

Based on the trial results, 1 death would be prevented in every 8 ventilated patients and 1 death prevented in every 25 patients requiring oxygen alone.

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, 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 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.”

Martin Landray, Professor of Medicine and Epidemiology at the Nuffield Department of Population Health, University of Oxford, one of the Chief Investigators, said:

“Since the appearance of COVID-19 six months ago, the search has been on for treatments that can improve survival, particularly in the sickest patients.

“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.”

The UK Government’s Chief Scientific Adviser, Sir Patrick Vallance, said:

“This is tremendous news today from the Recovery trial showing that dexamethasone is the first drug to reduce mortality from COVID-19.

“It is particularly exciting as this is an inexpensive widely available medicine. 

“This is a ground-breaking development in our fight against the disease, and the speed at which researchers have progressed finding an effective treatment is truly remarkable.

“It shows the importance of doing high quality clinical trials and basing decisions on the results of those trials.”