Dexamethasone reduces deaths in COVID-19 patients with severe complications

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The RECOVERY trial has found that the steroid dexamethasone reduces deaths by one-third in COVID-19 patients on ventilator and by one-fifth in patients receiving only oxygen. No evidence of benefit was seen in patients who did not require oxygen, and it does not help prevent COVID-19.

In a major breakthrough, preliminary findings from the RECOVERY Trial show that the low-dose dexamethasone — a type of steroid, which typically used to reduce inflammation — reduces the 28-day mortality rate by as much as 17% in COVID-19 patients. The greatest benefit was seen in patients who required ventilation. However, who no evidence of benefit was seen in patients who did not require oxygen.

According to a press release by the University of Oxford, dexamethasone reduced deaths by one-third in ventilated patients and by one-fifth in other patients receiving only oxygen. The results are yet to be published in a peer-reviewed journal.

The RECOVERY trial is a randomised, controlled trial. In all, 2,104 patients were randomised to receive dexamethasone (intervention group) once a day for 10 days and 4,321 patients received standard care (control group).

“Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result. 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,” Peter Horby, one of the Chief Investigators of the trial and Professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, said in the release.

“These preliminary results from the RECOVERY trial are very clear – dexamethasone reduces the risk of death among patients with severe respiratory complications,” Martin Landray, one of the Chief Investigators and Professor of Medicine and Epidemiology at the Nuffield Department of Population Health, University of Oxford, said in the release.

The RECOVERY trial tested five drugs, including dexamethasone, and convalescent plasma therapy. The trial began in March, but on June 8, recruitment to the dexamethasone arm was halted as the Steering Committee felt sufficient patients had been enrolled to establish whether the drug was effective or not.

Not to be used indiscriminately

Virologist Dr. Angela Rasmussen at Columbia University warns against indiscriminate used of dexamethasone, which is a corticosteroid that profoundly suppresses inflammation. The drug seems to work in patients with a cytokine storm that causes the severe inflammation associated with severe COVID-19.

In a tweet, she warns against indiscriminate use of the drug especially early in the disease as it would be counterproductive. She says: “Dexamethasone is such a potent anti-inflammatory, might be harmful if given to patients too early or with mild disease. Inflammation is critical for mounting an effective antiviral immune response. Steroids too early in infection could hinder virus clearance.”

She adds: “A lot of people think all inflammation is bad, but it’s an essential component of the host response to infection. Inflammation itself is important–it’s when that inflammation gets out of control that it is harmful, as in patients with severe COVID-19.”

She also warns: “Taking dexamethasone won’t prevent SARS-CoV-2 infection or treat mild COVID-19 and could actually make it worse by suppressing antiviral immunity. It’s not great to take corticosteroids long term. So please don’t call up your doctor demanding a prescription for dexamethasone.”

The World Health Organization too had cautioned against using steroids to treat COVID-19 patients. That is because the steroids suppress the immune system, which seems to help COVID-19 patients with severe illness. But such patients may still need a fully functioning immune system to fend off the virus itself, Nature says. “The RECOVERY trial suggests that at the doses tested, the benefits of steroid treatment may outweigh the potential harm,” Nature says.