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 ClinicalTrials.gov as of April 27, 2020.
What are your thoughts, and how do these results compare with those achieved with remdesivir?