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Independents' Day

Cheap steroid cuts Covid-19 deaths in intensive care trial

British researchers have found the first drug to improve survival of Covid-19, in a breakthrough that was hailed by the chief medical officer.

Dexamethasone has been confirmed to reduce death by up to one third in hospitalised patients with severe respiratory complications of the virus. 

The low-cost, and widely available, steroid is typically used to treat inflammation, allergies and other breathing conditions such as asthma and COPD, among others.

It has now been approved for NHS use for Covid-19.

In March, the University of Oxford’s RECOVERY trial was established as a randomised clinical trial to test a range of potential treatments, with over 11,500 patients ultimately enrolled from over 175 NHS hospitals.

Results show that dexamethasone reduced deaths by a third in ventilated patients, and by one fifth in other patients receiving oxygen only. It did not benefit patients who did not require respiratory support.

In total, 2,104 patients were randomised to receive dexamethasone 6mg once per day, by mouth or intravenous injection, for ten days. They were compared with 4,321 patients randomised to usual care alone. Among those who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).

According to these results, one death would be prevented by treatment of around eight ventilated patients, or around 25 patients requiring oxygen alone.

Welcoming the information, chief trial investigator Professor Peter Horby said: ‘Dexamethasone is the first drug to be shown to improve survival in Covid-19.

‘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.’

Chief medical officer Professor Chris Whitty also heralded it as ‘the most important trial result for Covid-19 so far’, adding: ‘Significiant reduction in mortality in those requiring oxygen or ventilation from a widely available, safe and well known drug. Many thanks to those who took part and made it happen. It will save lives around the world’.

The full details will be published as soon as possible.

Other trials into Covid-19 treatments that are currently ongoing in the UK include the PRINCIPLE trial, via nearly 800 GP practices, and the Remap-Cap trial in intensive care settings.

Readers' comments (7)

  • Very admirable work. Maybe LMWH next.

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  • Una Coales. Retired NHS GP.

    No surprise that dexamethasone helps in covid as it has long been used in medicine along with prednisolone another steroid to help as an adjunct treatment for asthma, bronchospasm, chest infections in chronic respiratory illnesses for its antinflammatory effects.

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  • Not very comforting if you were on the placebo arm of the dexamethasone trial.

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  • only helps in 1 in 8, don't know long term side effects or mortality rates post steroids. i wouldn't celebrate just yet.

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  • More to the point potent steroids are first line in the management of a cytokine storm syndrome, as I have been saying since April 22nd. What's interesting and sad about the RECOVERY trial is that it appears to have used low-dose dexamethasone. That is not how to treat cytokine storm - you throw everything at it, with high dose dexamethasone or methylprednisolone. Why this was not included as a trial arm escapes me; it's not as if the proposal hasn't been brought to their attention (by me). When or if anyone is bold enough to try this I expect even better results.

    LMWH is another essential part of treatment if clotting markers like D-dimer and fibrinogen are out of kilter. But the key to intervention is early diagnosis, which is possible with these tests above, serum ferritin and clear hypoxia. Thus I recommend widespread distribution of pulse oximeters (cheap!) and rapid bloods if the O2 saturation drops below 93% in someone suspected of having Covid-19.

    Despite numerous emails and letters I have had no response to my suggestions, from politicians, the CMO, the CSO, members of SAGE (one exception) or journalists. It's not for want of trying! And I doubt there are many clinicians, before this all began, who have ever seen or treated a cytokine storm. I have.

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  • Una Coales. Retired NHS GP.

    Looks like other countries have formed their own opinion of the NHS Recovery trial. Has our country become the laughing stock of the world in how we treat covid? https://www.spectator.com.au/2020/06/bring-on-britains-corona-clowns/?fbclid=IwAR312WKZeIJrqdgCpLCBeyemcTBgZ-BhHnyA0dF1RyLHTeeEZefz5bHk0hI

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  • An ITU senior registrar friend of mine in a large London Hospital told me that they had been using dexamethasone 20mg a day for their severe Covid-19 patients from the beginning of April. He further told me that their death rate was one of the lowest in the country.

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