Dexamethasone potential in treating COVID-19 patients

Dexamethasone has been reported to reduce deaths by up to a third in hospitalised patients with severe respiratory complications of COVID-19. The study is named the RECOVERY Trial (University of Oxford) and the results were made public ahead of the publication of the full paper.

Dexamethasone is a corticosteroid medication has been used to treat numerous conditions for around 60 years. It is remarkably inexpensive, and the researchers have issued guidance to hospitals to use the treatment from today.

The study randomised 2104 patients to receive dexamethasone 6mg once per day by mouth or by intravenous injection for 10 days, and they were compared with 4321 patients randomised to usual care alone (no other treatment has worked so far!). 

Results showed that dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003), and by one fifth in other patients receiving oxygen only (0.80 [ confidence interval 0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support.

However, the broad immunosuppression mediated by dexamethasone does raise the possibility that treatment could interfere with the development of a proper immune response against the virus, so we shall have to await more information before drawing final conclusions.

Larger randomised-controlled trials will be required to understand more completely the risks and benefits of dexamethasone for these patients. There were 22 trials evaluating various corticosteroids registered on as of April 27, 2020.

Recent news has mentioned that the dexamethasone component of the RECOVERY trial was halted because those receiving the drug were significantly more likely to survive.

What are your thoughts, and how do these results compare with those achieved with remdesivir?

Comments (2) Add yours ↓
  1. Roger Kirby Professor of Urology

    Demand for the generic drug dexamethasone has surged in America in a matter of days since researchers in the U.K. reported that the steroid reduced deaths in very sick Covid-19 patients, according to a major drug-purchasing firm.

    Orders for dexamethasone surpassed 2.8 million last week as the University of Oxford released study results on June 16, up from nearly 397,500 the prior week, which was more typical, according to Vizient Inc., one of the largest group-purchasing organizations in the U.S. for hospitals. On the day the study was released, demand rose 167%.
    This increase in the demand reflects the positive resultsthe study, which is resulting in higher use of the drug to treat Covid-19 patients and hospitals planning ahead for use in the future.
    There are concerns though that individuals in the US and elsewhere may be self medicating inappropriately with this powerful steroid.

    June 25, 2020 Reply
  2. Felix David Managing Editor

    A pre-print of the results of the dexamethasone study can be found here:

    June 25, 2020 Reply

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