Steroid found to help prevent deaths of sickest coronavirus patients

A cheap steroid has become the first life-saving treatment in the Covid-19 pandemic, described by scientists as a major breakthrough and raising hopes for the survival of thousands of the most seriously ill.

Dexamethasone is cheap, available from any pharmacy, and easily obtainable anywhere in the world. Investigators said the drug was responsible for the survival of one in eight of the sickest patients – those who were on ventilators – in the Recovery trial, the biggest randomised, controlled trial of coronavirus treatments in the world.

“It is the only drug so far shown to reduce mortality and it reduces it significantly,” said Peter Horby, a professor of emerging infectious diseases in the Nuffield department of medicine, at the University of Oxford, and one of the chief investigators of the trial. “It is a major breakthrough, I think.”

Prof Martin Landray, his co-chief investigator said the sickest patients could begin to be treated with the drug immediately. “The search has been on for a treatment that actually reduces the risk of dying. There hasn’t been one until today.

“This is a drug that is globally available. This is not an expensive drug. That is immensely important.”

A total of 2,104 patients were chosen at random to receive 6mg of dexamethasone once a day (either by mouth or by intravenous injection) for 10 days, and were compared with 4,321 patients chosen at random to continue with normal care alone. Among the latter group of patients, 28-day mortality was highest in those who required ventilation (41%), intermediate in those 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, the use of dexamethasone would prevent one death of around eight ventilated patients, or one of about 25 patients requiring oxygen alone.

Last week, the Recovery team, who have been trialling seven drugs and will add more, concluded that hydroxychloroquine did not benefit patients in hospital with Covid-19.