Trial shows dexamethasone reduces death in patients with severe complications of COVID-19

Results from a University of Oxford study found that the low-cost, low-dose steroid dexamethasone was revealed this week to have reduced COVID-19 deaths by up to one third in patients hospitalized with the disease.

This is the first time a therapy has demonstrated any ability to improve survival among patients with severe respiratory complications of COVID-19. The benefit was only seen, however, in seriously ill patients and was not observed in patients with milder cases.

The preliminary findings were welcomed by the World Health Organization (WHO).

“This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support,” WHO Director-General Tedros Adhanom Ghebreyesus said. “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.”

The trial, which began in March, enrolled more than 11,500 patients from over 175 National Health Service hospitals in the UK. A total of 2,104 patients were randomized and issued 6 mg of dexamethasone per day for 10 days, either by mouth or intravenously. They were compared to 4,321 patients randomized and only given the usual care. The trial results showed that one death would be prevented by dexamethasone treatment of around eight ventilated patients or around 25 patients requiring oxygen alone.

“This is an extremely welcome result,” said Peter Horby, professor of emerging infectious diseases at the University of Oxford and a chief investigator on the trial. “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”

Dexamethasone has been available since the 1960s as an anti-inflammatory for numerous conditions. WHO has listed it as an essential medicine since 1977 in various formulations. It is not patented and readily affordable in most countries.

The testing of dexamethasone was conducted as part of the Randomized Evaluation of COVid-19 thERapY (RECOVERY) trial in the UK, which was established to test a range of potential treatments for COVID-19. Other drugs tested have included antibiotics, HIV treatments, and steroids, as well as hydroxychloroquine, which has now been stopped due to a lack of efficacy. A similar halt was put on its use in the U.S. by the Food and Drug Administration earlier this week.

“This is tremendous news today from the Recovery trial showing that dexamethasone is the first drug to reduce mortality from COVID-19,” Sir Patrick Vallance, UK Chief Scientific Advisor, said of the news. “It is particularly exciting as this is an inexpensive, widely available medicine. This is a ground-breaking development in our fight against the disease, and the speed at which researchers have progressed finding an effective treatment is truly remarkable. It shows the importance of doing high quality clinical trials and basing decisions on the results of those trials.”