Dexamethasone is the first drug to save lives

Dexamethasone is the first drug to save lives

In a large experiment, the cheap and widely available steroid cuts deaths by one third among critically ill patients with COVID-19.

In a large experiment, the cheap and widely available steroid cuts deaths by one third among critically ill patients with COVID-19.

A randomized controlled clinical trial in the United Kingdom found that an uncommon and commonly used steroid could save the lives of people with serious illness with COVID-19. The drug, called dexamethasone, is the first to appear to reduce coronavirus deaths that have killed more than 430,000 people globally. In the experiment, deaths were reduced by about a third in patients who were on ventilator due to coronavirus infection.

It's a shocking result, says Kenneth Bailey, intensive care physician at the University of Edinburgh, UK, who works on the trial steering committee, called RECOVERY. It will have a huge global impact

The RECOVERY trial, launched in March, is one of the world's largest randomized controlled trials of coronavirus treatments; He is testing a range of possible treatments. The study included 2,100 participants who received dexamethasone at a low or moderate dose of six milligrams per day for ten days, and compared how they were compared to about 4,300 people who received standard care for coronavirus infection.

The effect of dexamethasone was more pronounced among seriously ill patients on ventilators. Those who were receiving oxygen therapy but were not on ventilators improved: their risk of death decreased by 20%. The steroid had no effect on people with mild cases of COVID-19 - those without oxygen or ventilation.

The RECOVERY study announced the results in a press release on June 16, but its researchers say they aim to quickly publish their results and that they share the results with UK and international regulators.

A rigorous study

It's a major breakthrough, says Peter Hurby, an infectious disease specialist at Oxford University in the UK and lead researcher on the experiment. Hurby notes that the use of steroids to treat viral respiratory infections such as COVID-19 was controversial. He says the data from steroid experiences during an outbreak of severe acute respiratory syndrome (SARS) and respiratory syndrome in the Middle East caused by related coronaviruses were not conclusive. However, due to the widespread availability of dexamethasone, and some promising results from steroid studies in previous outbreaks, Hurby says that RECOVERY investigators felt the importance of a treatment test in a rigorous clinical trial.

Treatment guidelines from the World Health Organization and many countries have warned against treating people with coronavirus with steroids, and some researchers have been concerned about anecdotal reports of the widespread steroid. Medications suppress the immune system, which can provide some relief from patients whose lungs are destroyed by an overactive immune response that sometimes appears in severe cases of COVID-19. But such patients may still need a fully functional immune system to repel the virus itself.

RECOVERY experience indicates that in the tested doses, the benefits of steroid treatment may outweigh the potential harm. Investigators said the study found no significant negative effects from the treatment. "This treatment can be given to almost anyone," says Hurby.

The response pattern - with a greater influence on severe COVID-19 and no effect on mild infections - coincides with the idea that an overactive immune response is likely to be harmful in serious long-term infections, says Anthony Fossey, president of the American National Institute of Allergy and Diseases. Infectious. "When you are so advanced that you are on a ventilator, you usually have an abnormal or hyperactive inflammatory response that contributes as much to morbidity and mortality as any direct viral effect."

"Finding effective treatments like this will change the impact of the COVID-19 epidemic on life and economies around the world," said Nick Kamak, president of COVID-19 Therapeutics Accelerator at Wellcome, a medical biomedical medical charity in London. statement. "While this study indicates that dexamethasone only benefits severe cases, countless lives will be saved worldwide."

Easy to manage

To date, the only drug that has been shown to benefit COVID-19 patients in a large, randomized controlled clinical trial is an antiviral drug. Although remdesivir1 was shown to shorten the amount of time patients would need in hospital, it had no statistically significant effect on mortality.

Remdesivir is also in short supply. Although drug maker - Gilead Sciences of Foster City, California - has taken steps to increase Remdesivir production, it is currently only available to a limited number of hospitals around the world. The remdesivir is complicated to give: it must be given by injection over several days.