A cheap and widely available steroid called dexamethasone has been shown to reduce COVID-19 deaths, according to the preliminary results of a large clinical trial released on 16 June. Deaths of patients on ventilators were cut by around 30 per cent and deaths of patients requiring oxygen were reduced by 20 per cent.
The COVID-19 infection caused by the novel coronavirus (Sars-CoV-2) has claimed the lives of more than 430,000 people worldwide. Dexamethasone is the first drug to show reduced deaths from the coronavirus in a randomized, controlled clinical trial in the UK called RECOVERY, which is testing a range of potential therapies for treating the coronavirus.
The drug has been used for more than 50 years to reduce inflammation caused by various conditions including autoimmune disorders, severe asthma, allergies and painful, swollen joints, as well as certain cancers.
A total trial 2,100 participants received a low or moderate dose of dexamethasone per day while 4,300 received standard treatment. The researchers from the University of Oxford found that the steroid treatment was most effective for critically ill patients on ventilators but had no effect on mild cases of COVID-19.
The UK government has since authorized use of the drug for hospitalised COVID-19 patients requiring oxygen, including those on ventilators.
Thus far, remdesivar is the only drug shown to be effective in treating the coronavirus in a large randomised clinical trial but does not have any effect on deaths. Moreover, the drug is in short supply – although drugmaker Gilead is ramping up production – and difficult to administer: the drug must be injected over the course of a few days. Dexamethasone, on the other hand, is widely available from pharmacies in pill form.
In a statement, WHO Director-General Dr Tedros Adhanom Ghebreyesu said: “This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support”.
“This is great news and I congratulate the Government of the UK, the University of Oxford, and the many hospitals and patients in the UK who have contributed to this lifesaving scientific breakthrough”.
Previous trials of steroids for treating SARS and the Middle East respiratory syndrome (MERS) outbreaks – which are also caused by coronaviruses – were inconclusive. However, promising results prompted a more rigorous clinical trial of dexamethasone for treating COVID-19.
Some experts have expressed concern about the use of steroids to treat coronavirus infections. Steroids reduce inflammation by suppressing the immune response and a fully functioning immune system is required to fight off the virus. Nonetheless, the hyperactive immune response in severe infections is likely to do more in the long-term, said Anthony Fauci, head of the US National Institute of Allergy and Infectious Disease.
Fauci explained: “When you’re so far advanced that you’re on a ventilator, it’s usually that you have an aberrant or hyperactive inflammatory response that contributes as much to the morbidity and mortality as any direct viral effect.”
Indeed, the preliminary findings, which have not yet been published in a peer-reviewed journal, suggest that unlike other drug candidates for treating COVID-19, such as hydroxychloroquine, the benefits of dexamethasone treatment may outweigh the potential harm.