UK experts say low-dose steroid treatment of dexamethasone represents a major advance in the fight against the deadly virus.
The drug is part of the world’s largest trial testing current treatments to see if they also work for the coronavirus.
Reduce the risk of death by a third for patients using ventilators. For those who use oxygen, it has reduced deaths by a fifth.
If the drug had been used to treat patients in the UK since the start of the pandemic, the researchers say, up to 5,000 people would have been saved.
And it could be of great use in poor countries with large numbers of Covid-19 patients.
The UK government has 200,000 cycles of the drug in stock and says the NHS will make dexamethasone available to patients.
England’s chief medical officer, Professor Chris Whitty, said it would save lives around the world.
About 19 out of 20 patients infected with the coronavirus recover without being hospitalized.
Most of those admitted to the hospital recover, but others may require oxygen or mechanical ventilation.
For the high-risk patient, dexamethasone seems to help.
The drug is actually used to reduce inflammation in a variety of other conditions, such as arthritis, asthma, and some skin conditions.
It appears to help stop some of the damage that can occur when the body’s immune system ramps up while trying to fight coronavirus.
Remdesivir, developed by Gilead, is in short supply, so the question of which patients benefit the most may be extremely important in determining who gets the drug.
The study authors argue that the difference in death rates is due to the fact that there are fewer patients whose symptoms were more severe at the start of the study, resulting in decreased statistical power.
But the benefit seemed to be much greater among those who were less sick.
The preliminary results of the study, which led to an emergency clearance for the drug by the Food and Drug Administration, were released late last month. The full data was published Friday night in the New England Journal of Medicine.
It’s a very safe and effective drug, But Tobol noted that there were no signs of benefit in patients who entered the study in the most severe baseline condition: those who underwent non-invasive ventilation, who were intubated with a ventilator, or who received extracorporeal oxygen, which is a treatment.
“We need something that works for these patients who have a high mortality rate,” Tobol said.
Recovery with Remdesivir:
Remdesivir, the only drug licensed to treat Covid-19, has speeded up recovery time for patients with the disease, but its benefit appears to have been more limited in patients who require ventilators as part of their treatment, according to results from a clinical trial the expected.
Among patients who scored 4 points, there was a 38% benefit in speedy recovery.
Among those who scored 5, there was a benefit of 47%. But this advantage decreased to 20% among those with a score of 6, which means they were receiving high-flow ventilation, and it decreased by 0.05% among those who scored 7, which means that they had been intubated or had membrane oxygenation outside the body.
Until more data is available, clinicians and researchers will likely debate whether to use remdesivir in the sickest patients.
A large trial of dexamethasone showed that an inexpensive steroid could reduce deaths in hospitalized patients with severe COVID-19 by up to a third, making it the first drug to show life-saving benefits for these patients.
Preliminary results from a RECOVERY trial of 2,104 patients led by the University of Oxford in the United Kingdom showed that dexamethasone reduced deaths by a third in the ventilated patients and by a fifth in the other oxygen-only patients.
There was no benefit among patients with less severe disease who did not require ventilation.
These results are in line with the drug’s known mechanism to reduce inflammation, which plays a key role in more severe cases.
The results were hailed internationally as a breakthrough in the treatment of hospitalized patients with severe infection from COVID-19, especially as the widespread availability of the drug will allow its rapid use around the world.
To provide real-time information on the epidemic, the results were announced as quickly as possible, but the results will be peer-reviewed and published in a medical journal soon.