Researchers unveil first drug shown to improve COVID-19 survival rates

The trials found dexamethasone is most effective when used on ventilated patients, while it can also reduce coronavirus-related deaths by one fifth in patients who receive oxygen only.
 
According to the researchers, administering dexamethasone would prevent one death in around eight ventilated patients, or around 25 patients requiring oxygen alone. However, use of the steroid showed no benefit among those patients who did not require respiratory support.
 
One of the trial’s Chief Investigators, Professor Peter Horby from Oxford’s Emerging Infectious Diseases unit, described the findings as ‘extremely welcome’.
 
‘Dexamethasone is the first drug to be shown to improve survival in COVID-19,’ he said.
 
‘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.’

A total of 2104 patients were randomly selected to receive dexamethasone 6 mg once per day, either by mouth or intravenous injection, for 10 days and were compared with 4321 patients who received 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%).

Research into dexamethasone formed part of the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial, which has so far involved more than 11,500 patients across more than 175 NHS hospitals in the UK and is designed to test a range of potential treatments for COVID-19.

Fellow Chief Investigator Martin Landray, Professor of Medicine and Epidemiology at the University of Oxford, said preliminary results from the RECOVERY trial are clear.
 
‘Dexamethasone reduces the risk of death among patients with severe respiratory complications,’ he 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 … it is fantastic that the first treatment demonstrated to reduce mortality is one that is instantly available and affordable worldwide.’

The low-cost, widespread availability of dexamethasone contrasts with the only other drug shown to benefit COVID-19 patients in a large, randomised, controlled clinical trial – remdesivir.
 
According to Nature, the antiviral is in short supply and currently only available to a limited number of hospitals around the world. It is also more difficult to administer – it must be delivered via injection over several days – and has only been shown to shorten the amount of time patients may need to spend in the hospital, rather than a statistically significant reduction in deaths.
 
However, while news of the apparent breakthrough has been met with enthusiasm by many in the medical community, University of Adelaide senior lecturer Dr Ian Musgrave said the findings should be interpreted with caution.
 
‘So far we only have press releases to go on, the actual study data have not been released so this needs to be examined carefully. The retracted Lancet paper on hydroxychloroquine has taught us that lesson,’ he said.

‘Also, it was only effective in people who needed ventilation support; dexamethasone was of no benefit to those not on breathing support. As well, because dexamethasone is a powerful anti-inflammatory and immune suppressant, it still must be used with care.
 
‘Finally, we must be very clear that dexamethasone, if it proves to be as useful as the press release claims, is not a preventative or general treatment, but is only for the most severe cases of COVID-19 that require respiratory support. This in itself is good news, but it must not be exaggerated.’

According to the University of Oxford, the researchers are working to publish the full details of the trial ‘as soon as possible’.
 
The National COVID-19 Clinical Evidence Taskforce has said it will incorporate this evidence into its rapid guideline development process and make appropriate recommendations about the use of this treatment on Australian patients once it becomes available.
 
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