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Commonly-Used Steroid May Be Life-Saving COVID-19 Treatment

Commonly-Used Steroid May Be Life-Saving COVID-19 Treatment

Dexamethasone could be a game-changer for seriously ill COVID-19 patients who need oxygen support.

Updated on June 16, 2020 at 2:00pm EST.

A relatively cheap, safe drug commonly used to treat a range of inflammatory conditions could be a game-changer in the fight against COVID-19.

Researchers in the UK announced some preliminary findings of the RECOVERY (Randomized Evaluation of COVID-19 Therapy) trial, which was launched back in March to evaluate several existing drugs as possible treatments for COVID-19—the disease caused by the coronavirus known as SARS-CoV-2.

The team found that low-dose dexamethasone could reduce deaths by up to one-third in very severe cases of COVID-19.

“Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result,” said chief investigator, Peter Horby, who is also professor of emerging infectious diseases in the Nuffield Department of Medicine at the University of Oxford, in a news release.

“The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients,” Dr. Horby added. “Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”

What is dexamethasone?
Dexamethasone is a steroid. It’s used to suppress the immune system and ease inflammation, swelling and edema. It’s prescribed to help manage certain forms of arthritis, severe allergies, asthma and cancer as well as some skin, blood, kidney, eye, thyroid and intestinal disorders.

Dexamethasone is also used to help treat acute mountain sickness—a potentially fatal condition in which fluid leaks and accumulates in the lungs.

How could it work against COVID-19?
Most people with COVID-19 recover without the need for oxygen or being put on a ventilator. But roughly 15 percent of cases result in severe illness and complications, including pneumonia and trouble breathing. Another 5 percent will develop very serious issues, including respiratory failure.

A virus like SARS-CoV-2, which causes COVID-19, can also lead to inflammation that triggers an overwhelming release of proteins called cytokines. Normally, cytokines help coordinate the body’s response to infection. But in some cases, this response can range out of control, doing more harm than good.

Dexamethasone may help these seriously ill COVID-19 patients.

What did the researchers find?
The RECOVERY trial recruited more than 11,500 patients from more than 175 hospitals in the UK to assess the benefits of six existing drugs against COVID-19.

For the dexamethasone study, in particular, the researchers included a total of 2,104 people. These patients were randomly assigned to receive a low dose (6mg) of the steroid daily for a period of 10 days. They were compared to a control group of 4,321 patients who received typical care.

After monitoring the patients for 28 days, the researchers found that treatment with dexamethasone reduced deaths by one-third among the patients on ventilators and reduced deaths by 20 percent among patients on oxygen. They noted the drug did not appear to have a benefit for less-seriously ill patients who did not need oxygen support.

Based on these preliminary findings, which have yet to be published, the researchers estimated that among 25 people with COVID-19 who require oxygen, dexamethasone could prevent one death, or the drug could prevent one death among eight ventilated patients.

“These preliminary results from the RECOVERY trial are very clear—dexamethasone reduces the risk of death among patients with severe respiratory complications,” said co-chief investigator, Martin Landray, professor of medicine and epidemiology at the Nuffield Department of Population Health at the University of Oxford, in a news release. “COVID-19 is a global disease—it is fantastic that the first treatment demonstrated to reduce mortality is one that is instantly available and affordable worldwide.”

Other treatments being evaluated
The RECOVERY trial is also investigating the effectiveness of the following drugs as potential COVID-19 treatments: 

  • Lopinavir-Ritonavir, which is sold under the brand name Kaletra (an HIV-drug)
  • Azithromycin (an antibiotic)
  • Tocilizumab, which is sold under the brand name Actemra (an injectable anti-inflammatory treatment)
  • Convalescent plasma with SARS-CoV-2 antibodies (collected from people who have recovered from COVID-19)

The RECOVERY trial also explored the possible benefits of the anti-malaria drug hydroxychloroquine against COVID-19. The researchers found the drug, which is also used to treat arthritis and lupus, has no benefit for hospitalized COVID-19 patients and immediately halted further study of the drug against the disease.

After evaluating a total of 1,542 patients treated with hydroxychloroquine and comparing them to a control group of 3,132 patients who received standard care, the researchers found no differences in outcomes between the two groups after 28 days.

Medically reviewed in June 2020.

Sources:
University of Oxford. “Low-cost dexamethasone reduces death by up to one third in hospitalized patients with severe respiratory complications of COVID-19.”
U.S. National Library of Medicine. “Dexamethasone.”
UpToDate. “Patient education: High altitude illness (including mountain sickness) (Beyond the Basics).”
University of Oxford. “This national clinical trial aims to identify treatments that may be beneficial for people hospitalized with suspected or confirmed COVID-19.”
University of Oxford. “No clinical benefit from use of hydroxychloroquine in hospitalized patients with COVID-19.”

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