For the first time, dexamethasone, a cheap and widely available steroid used to reduce inflammation and treat conditions like rheumatoid arthritis and asthma was found to reduce deaths by a third in hospitalized COVID-19 patients. Even though full data from the study have yet to be published nor systematically reviewed, the preliminary result had received significant attention from various channels including the World Health Organization (WHO).
What does the result say?
The study forms part of the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial established by the University of Oxford in March which aims to test a range of potential treatments ranging from low dose dexamethasone; Lopinavir-Ritonavir (medication for HIV/AIDS); Azithromycin (antibiotic); Tocilizumab (an injected form of anti-inflammatory treatment) to Convalescent plasma (collected from fully recovered COVID-19 patients who have antibodies against the SARS-CoV-2 virus), and Hydroxychloroquine (anti-malarial drug; this has been stopped due to lack of efficacy).
More than 11,000 COVID-19 positive patients were randomly assigned to receiving either of the above with no other additional treatment as they were admitted to 175 National Health Service (NHS) hospitals across the UK. By 8 June, a total of 2104 randomized patients were administered orally or via intravenous injection 6mg of dexamethasone once every day for consecutive ten days. Their progress was compared with 4321 randomized patients who were given usual care.
Researchers found that among those who had received usual care alone, their 28-day mortality was highest among those on ventilation (41%) and oxygen supply (25%) and lowest among those who did not require respiratory intervention (13%). On the other hand, deaths were reduced by one-third in ventilated patients on dexamethasone and by one-fifth in patients on oxygen supply. Dexamethasone does not have a significant benefit on patients who did not require respiratory support.
Based on the findings, researchers believe one death would be prevented for every treatment of around eight ventilated patients and 25 patients needing oxygen supply.
A finding still subjected to further question
In a press release issued yesterday (16 June), The UK government’s Chief Scientific Adviser, Sir Patrick Vallance called the study a “tremendous news” and a “ground-breaking development in our fight against the disease”. Peter Horby, Professor of Emerging Infectious Diseases at the Nuffield Department of Medicine and the study’s Chief Investigators called it “an extremely welcome result” because “dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide”.
Nevertheless, another of the study’s Chief Investigator, Martin Landray, Professor of Medicine and Epidemiology at the Nuffield Department of Population Health told Associated Press, the findings have big effects; “it’s not a cure, but it’s certainly a long way forward.” Indeed, after two prominent journals, The New England Journal of Medicine (NEJM) and the Lancet retracted two high profile COVID-19 papers concerning Angiotensin-converting-enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs) and benefits of anti-malarial drugs – chloroquine and hydroxychloroquine, the science community has become more cautious over major findings.
Dr. Scott Gottlieb, former Commissioner of the US Food and Drug Administration (FDA) told CNBC, “I think it needs to be validated, but it certainly suggests that this could be beneficial in this setting”. Atul Gawande, Surgeon, writer and public health researcher tweeted “after all the retractions and walk backs, it is unacceptable to tout study results by press released without releasing the paper”.
The RECOVERY trial team said they are “working to publish the full details as soon as possible” given “the public health importance of these results”.