The World Health Organization (WHO) welcomes the initial clinical trial results from the United Kingdom (UK) that show dexamethasone, a corticosteroid, can be lifesaving for patients who are critically ill with COVID-19. 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, according to preliminary findings shared with WHO.
THIS IS THE FIRST TREATMENT TO BE SHOWN TO REDUCE MORTALITY IN PATIENTS WITH COVID-19 REQUIRING OXYGEN OR VENTILATOR SUPPORT,” SAID DR TEDROS ADHANOM GHEBREYESUS, WHO DIRECTOR-GENERAL. “THIS IS GREAT NEWS AND I CONGRATULATE THE GOVERNMENT OF THE UK, THE UNIVERSITY OF OXFORD, AND THE MANY HOSPITALS AND PATIENTS IN THE UK WHO HAVE CONTRIBUTED TO THIS LIFESAVING SCIENTIFIC BREAKTHROUGH.”
In March 2020, the RECOVERY trial was established as a randomised clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). Over 11,500 patients have been enrolled from over 175 NHS hospitals in the UK.
A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).
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 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75; p=0.14).
Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone.
Given the public health importance of these results, the researchers are now working to publish the full details as soon as possible.