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Peter Horby couldn’t believe his eyes.
He’d just gotten his first glimpse of new data from the United Kingdom’s Recovery Trial, an experiment enrolling tens of thousands of patients at dozens of hospitals for clinical trials investigating Covid-19 therapies.
Horby and his Oxford University colleague Martin Landray had dreamed up the trial program in March 2020. Nearly three months later, more than 35,000 people were dead in the UK (and more than 100,000 in the US), and Horby and Landray were still hunting for the world’s first lifesaving treatment for the novel coronavirus.
Now Horby was looking at the results of a Recovery Trial project testing dexamethasone, a cheap,…
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The race for an effective treatment for Covid-19 has been littered with false starts and uncertain outcomes. To date, no treatment improves the odds of Covid-19 patients surviving.
However, one relatively common and inexpensive drug has emerged with the strongest evidence yet of improving Covid-19 survival and mortality in severely ill patients.
Although full trial data have not yet been released, several outside commentators hailed the result as a “breakthrough.”
A steroid, dexamethasone, is the first drug shown to help save severely ill coronavirus patients, according to scientists in Britain.
The results of a trial that found dexamethasone reduced the risk of death in extremely ill coronavirus patients have yet to be published, but some doctors are already embracing them.
In just three months, one British research team identified the first life-saving drug of the pandemic (and helped cancel hydroxychloroquine).
The other thing to emphasize... is that none of these drugs directly alter the pandemic itself. They will save more lives when people get infected, but we really need to try to keep more people from getting infected in the first place, especially now that it’s become more apparent that social distancing and as trivial a thing as public use of face masks can help. We could be mitigating this pandemic with such measures in this country, but in too many regions we don’t seem to be doing that. Eventually, though, what makes this disease go away will be a vaccine.
“It’s clear that dexamethasone has had a big impact,” noted Horby. “A million is a big number … It’s an estimate that could well be lower than that or higher than that. We don’t know.”
“We have a drug that improves survival [and] the drug is extremely cheap and widely available,” Dr. Horby said in an interview. “It can be given to almost everybody,” with some exceptions, including pregnant women, he said.
The research team reported that a 6-milligram daily dose of dexamethasone reduced deaths by one-third in Covid-19 patients on ventilators and reduced deaths by one-fifth for patients receiving just oxygen support.
Dexamethasone has been around since the early 1960s. It is a steroid often given in low doses as an anti-inflammatory. It is used widely for severe asthma, allergies and when joints are painful and swollen. It is also used in autoimmune conditions such as systemic lupus erythematosus or more commonly in rheumatoid arthritis. It’s this effect on inflammation and our immune systems that makes it useful in fighting off the worst effects of COVID-19.
The Food and Drug Administration has not approved dexamethasone to treat patients with Covid-19 in the hospital or at home. In addition, Covid-19 treatment guidelines from the National Institutes for Health specifically recommend against using dexamethasone use in patients who do not need oxygen, as the RECOVERY trial did not show it benefitted these patients and potentially showed evidence of harm.
The United Kingdom is not a pandemic success story. But its massive Covid-19 trials program is.
According to preliminary findings shared with WHO (and now available as a preprint), for patients on ventilators, the treatment was shown to reduce mortality by about one third, and for patients requiring only oxygen, mortality was cut by about one fifth.