The widely available steroid drug dexamethasone may be key in helping to treat the sickest Covid-19 patients in the hospital who require ventilation or oxygen, according to researchers in the United Kingdom. Their findings are preliminary, still being compiled, and have not been published in a peer-reviewed journal — but one outside expert called this a "breakthrough."
The two lead investigators of the Recovery Trial, a large UK-based trial investigating potential Covid-19 treatments, announced to reporters in a virtual press conference on Tuesday that a low-dose regimen of dexamethasone for 10 days was found to reduce the risk of death by a third among hospitalized patients requiring ventilation in the trial.
"That’s a highly statistically significant result," Martin Landray, deputy chief investigator of the trial and a professor at the University of Oxford, said on Tuesday.
"This is a completely compelling result. If one looks at the patients who did not require ventilators but were on oxygen, there was also a significant risk reduction of about one-fifth," Landray said. "However, we didn’t see any benefit in those patients who were in hospital, had Covid, but whose lungs were working sufficiently well -- they were not taking either oxygen or on ventilators."
Landray added that "there are outstanding questions" and people treating Covid-19 at home should not be taking dexamethasone on the back of these results.
"We have not studied patients in the community," Landray said. "We show no effect in the patients who are not on oxygen and we did not study the patients who are not in hospital."
About the trial: The dexamethasone arm of the Recovery Trial — which closed last week and researchers are now compiling its data — included about 2,100 hospitalized Covid-19 patients who were randomized to receive dexamethasone and about 4,300 hospitalized Covid-19 patients who were randomized to receive the usual standard of care at their hospitals.
In the trial, dexamethasone was provided at a dose of 6mg once a day for up to 10 days, administered either as an injection or taken orally. The researchers reported no serious adverse events among the patients taking dexamethasone, but the results are preliminary.
"At this stage, we found no clear adverse effects of doing this. Let’s recognize that there are sort of two messages here. In the people who required oxygen or ventilation, it clearly works, and the benefits are biggest for those on ventilators. In the people in hospital with Covid who do not require oxygen -- so, their lungs are working moderately well -- then actually there’s no benefit," Landray said on Tuesday.
He continued: "In the trial, our focus was on mortality, which obviously a drug can affect in either direction, but the overall results in the patients on oxygen and ventilation was a clear, clear benefit. We’ve looked, for example, were there deaths due to other forms of infection, which are sometimes considered a risk? And the answer is no, there was no excess of any other particular cause of death."