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Low-cost dexamethasone hits the mark in COVID-19 study

Reduced deaths by one-third among ventilated patients

clinical trial

A low-cost steroid treatment, dexamethasone, has demonstrated impressive efficacy against COVID-19 in a large-scale study led by the University of Oxford.

The promising results come from the RECOVERY trial, which was initiated in March. The study was established to test a number of potential COVID-19 treatments, including low-dose dexamethasone, lopinavir-ritonavir, hydroxychloroquine, azithromycin and more.

The nationwide study has already enrolled 11,500 patients from over 175 NHS hospitals across the UK, although recruitment to the dexamethasone arm was halted on 8 June after a sufficient number of participants was reached.

Overall, 2,104 patients received dexamethasone treatment for a period of ten days, and were compared to 4,321 who received standard of care. Among the standard of care arm, 28-day mortality was highest among those who required ventilation (41%), while those who required oxygen only or no respiratory intervention had lower mortality rates (25% and 13% respectively).

The initial results from the study demonstrated that dexamethasone reduced deaths by one-third in patients on ventilation, and by one-fifth in patients receiving oxygen only. According to researchers, this means that one death would be prevented by dexamethasone treatment in around eight ventilated patients or around 25 patients requiring oxygen.

“Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result,” said Peter Horby, professor of Emerging Infectious Diseases at the Nuffield Department of Medicine, University of Oxford, and one of the chief investigators for 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,” he added.

Dexamethasone is already approved to reduce inflammation in a number of diseases and conditions, including arthritis, asthma and certain skin conditions. Its anti-inflammatory nature appears to reduce the severity of cytokine storm associated with COVID-19, which occurs when the body’s immune system overreacts in an attempt to rid itself of the virus.

A number of anti-inflammatories are also being researched in COVID-19, with the similar hope that they can counteract this overactive immune response and help to prevent death. That includes Eli Lilly’s JAK inhibitor baricitinib and Roche’s IL-6 inhibitor Actemra, which has already been approved in China for the treatment of severely-ill COVID-19 patients with lung complications.

“This is tremendous news from the Recovery trial showing that dexamethasone is the first drug to reduce mortality from COVID-19. It is particularly exciting as this is an inexpensive, widely available medicine,” said Sir Patrick Vallance, the UK Government’s chief scientific adviser.

“This is a ground-breaking development in our fight against the disease, and the speed at which researchers have progressed in 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,” he added.

Article by
PMGroup

17th June 2020

From: Research

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