Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19
The scientists have been sceptic over the rationale for prolonged corticosteroid treatment in the Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19. This has been studied by Villar et al1 recently where the authors talk about the scepticism based on evidence from only four small studies that suggests that patients are not being benefitted by steroid treatment2,3. However, studies from Wuhan, China4 and Itlay5 recommend use of steroids for ARDS caused by COVID-19. Now more concrete evidence has come from RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial6 in favour of steroids by using dexamethasone for the treatment of severely ill COVID-19 patients in a randomised trial by a team of scientists from the University of Oxford, UK.
Over 11,500 patients have been enrolled from over 175 NHS hospitals in the UK to test various non-biological and biological drugs including hydroxychloroquine, anti-viral drugs and Tocilizumab. The trial which has been running since March 2020 has eventually seen a clear winner from the drugs used in a fight against COVID-19 and that is dexamethasone. Hydroxychloroquine was abandoned due to increased fatalities and heart problems while other drugs have been tried for COVID-19 as well, although with relatively less effectiveness as far as RECOVERY trial is concerned.
A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for 10 days and were compared with 4321 patients who did not receive the drug. Among the patients who didn’t receive the drug, 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%). Dexamethasone reduced deaths by 33% in ventilated patients and by 20% in other patients receiving oxygen only. However, there was no benefit among those patients who did not require support for breathing.
Steroidal drugs have also been used in other studies involving COVID-19. In a study published by Lu et al7, 151 patients out of 244 patients were given a combination of antiviral drugs along with adjuvant corticosteroid treatment (median hydrocortisone-equivalent dosage 200 [range 100–800] mg/day). In this study, low survival rate (30%) was seen at 28 days with patients receiving such a high dosage of steroids compared to those who didn’t (80%).
Dexamethasone has already been used to reduce inflammation in a range of other conditions. In case of COVID-19, dexamethasone seems to reduce the inflammation caused by the cytokine storm that develops as a consequence of COVID-19 infection. Thus, this drug seems to be the miracle cure for high-risk COVID-19 patients that require hospitalisation. The treatment regimen of dexamethasone is up to 10 days and costs 5 pounds per patient. This drug is globally available and can be used to save lives of COVID-19 patients going forward.
More studies with dexamethasone need to be conducted across various countries and ethnic groups worldwide to establish its efficacy for COVID-19.
Have researchers finally found a low-cost, easily available, miracle cure for severe COVID-19 patients worldwide? The Oxford University group reports that low-cost dexamethasone reduces death by up to 33% in hospitalised patients with severe respiratory complications of COVID-19.
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References:
1. Villar, J., Confalonieri M., et al 2020. Rationale for Prolonged Corticosteroid Treatment in the Acute Respiratory Distress Syndrome Caused by Coronavirus Disease 2019. Crit Care Explor. 2020 Apr; 2(4): e0111. Published online 2020 Apr 29. DOI: https:///doi.org/10.1097/CCE.0000000000000111
2. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020; 395:473–475
3. Delaney JW, Pinto R, Long J, et al. The influence of corticosteroid treatment on the outcome of influenza A(H1N1pdm09)-related critical illness. Crit Care. 2016; 20:75.
4. Shang L, Zhao J, Hu Y, et al. On the use of corticosteroids for 2019-nCoV pneumonia. Lancet. 2020; 395:683–684
5. Nicastri E, Petrosillo N, Bartoli TA, et al. National institute for the infectious diseases “L. Spallanzani”, IRCCS. Recommendations for COVID-19 clinical management. Infect Dis Rep. 2020; 12:8543.
6. Oxford University News Release. 16 June 2020. Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19. Available online at https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf Accessed on 16 June 2020.
7. Lu, X., Chen, T., Wang, Y. et al. Adjuvant corticosteroid therapy for critically ill patients with COVID-19. Crit Care 24, 241 (2020). Published 19 May 2020. DOI: https://doi.org/10.1186/s13054-020-02964-w
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