Resources around us if used diligently, can save humanity. Dexamethasone (Dexa) – a low-cost anti-inflammatory drug has proven it. Dexamethasone has lived up to the expectation in the Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial. Preliminary data have shown that steroid medication reduces death by up to one third among patients with severe respiratory complications of COVID-19.
A comparison of 2104 patients randomised to receive Dexa 6 mg once per day, either by intravenous injection or mouth, for ten days, was done with 4321 patients randomised to receive the usual care. By 28 days, 41%, 25%, and 13% of the patients on ventilation, oxygen only, and on no breathing support respectively, died among the usual care arm. Among those receiving Dexa, deaths reduced by one-third in those that required ventilation, and by one-fifth among those that required oxygen only. The investigators observed no benefit among patients who needed no breathing support.
The results show that we can save one patient for every eight that require ventilation or 25 that requires oxygen alone if they receive Dexa.
Dexamethasone is the first drug that has shown to improve survival in COVID-19 – professor Peter Horby noted. It is cheap and universally available. Professor Martin Landray highlights the clarity of the preliminary results from the RECOVERY trial, with Dexa, a globally available yet affordable medication. Both professors are some of the chief investigators for the study.
The RECOVERY trial, established in March 2020, is a large, randomised controlled trial of potential treatments for patients admitted to hospitals with COVID-19. To date, the investigators have randomised about 11,500 patients to receive at least one of the six treatment modalities, or no additional treatment. Patients receive either Lopinavir-Ritonavir, low-dose Dexa, hydroxychloroquine, azithromycin, tocilizumab, or convalescent plasma. The investigators have discontinued hydroxychloroquine due to the lack of efficacy during the clinical trial.
With a grant from various partners, the University of Oxford supports the trial. The registered, clinical trials units with the Nuffield Department of Population Health, in partnership with the Nuffield Department of Medicine, are conducting this trial. It has involved over 175 hospitals across the UK.
Read the NEJM for another article about the same.