Dexamethasone can Now Save Lives Among COVID-19 Patients: RECOVERY Trial

Dexamethasone is the first life-saving drug that has shown to improve survival in COVID-19 patients. It is an inexpensive drug and is available in all countries around the world. This drug can be administered immediately to save lives worldwide. Benefits of Dexamethasone

Dexamethasone was first discovered in 1957 and was approved in 1961 for medical use. It is commonly prescribed to treat many conditions for a short or long time to reduce inflammation including organ transplantations. Its benefit in critically ill patients who are on mechanical ventilation for breathing could have potentially saved up to 5000 lives in the UK.

Low-cost dexamethasone can lower deaths by one-third in hospitalized patients with severe respiratory complications of COVID-19.

Professor Peter Horby and Professor Martin Landray, chief investigators of the Randomised Evaluation of COVid-19 thERapY (RECOVERY) trial, said: “In March of this year, RECOVERY was established as a randomized clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). Over 11,500 patients have been enrolled from over 175 NHS hospitals in the UK.”

Details of the Study

Randomized Evaluation of COVid-19 thERapY (RECOVERY) trial was established as a randomized clinical trial to test a range of potential treatments for COVID-19.

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The RECOVERY trial-tested five drugs including low-dose dexamethasone (a steroid treatment), lopinavir / ritonavir, hydroxychloroquine (stopped due to lack of efficacy), azithromycin, tocilizumab and convalescent plasma therapy.

The clinical trial began in March, but on June 8th, recruitment to the dexamethasone arm was halted. The trial Steering Committee felt sufficient patients had been enrolled to establish whether or not the drug was effective.

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About 2104 patients were randomized to receive 6 mg of dexamethasone once per day. They were administered either by mouth or by intravenous injection for ten days. Later, they were compared with 4321 patients randomized who did not receive the drug.

Results of the Study

After 28 days, the research team found that dexamethasone was effective in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest in 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. However, there was no benefit in patients who did not require respiratory support.

The research team has said that one death could be prevented by the treatment of around eight ventilated patients or 25 patients requiring oxygen alone. The team is working on publishing the full details of the study as soon as possible.

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 the standard of care in these patients. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”

Interestingly routine use of corticosteroids previously for treatment of viral pneumonia administered to patients with SARS-COV (Severe Acute Respiratory Syndrome) reported no survival benefit and possible harms (avascular necrosis, psychosis, diabetes, and delayed viral clearance).

A systematic review of observational studies in influenza found a higher risk of mortality and secondary infections with corticosteroids; the evidence was judged as very low 9 to low quality due to confounding by indication.

Finally, a recent study of patients receiving corticosteroids for MERS-COV (Middle East respiratory syndrome coronavirus) used a similar statistical approach and found no effect of corticosteroids on mortality but delayed lower respiratory tract (LRT) clearance of MERS-CoV.

Summary

Dexamethasone may become the "magic bullet" that helps us win the war against coronavirus (COVID-19). We can now help in saving seriously-ill COVID-19 patients.

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.”

Reference:

1. Revised Guidelines on Clinical Management of COVID – 19 - (https://www.mohfw.gov.in/pdf/RevisedNationalClinicalManagementGuidelineforCOVID1931032020.pdf)

Source-Medindia