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Dexamethasone - cheap antiinflamatory corticosteroid lowers mortality by 1/3 for covid ICU cases
AHPPC notes the preliminary media reports of the results of a randomised trial of the use of dexamethasone, a corticosteroid, in the management of hospitalised patients with COVID-19.
Whilst only a single trial, it appears to be a large well-conducted study. The investigators reported a significant reduction in mortality in patients on mechanical ventilation and in those requiring oxygen, but not in those with less severe illness. AHPPC notes that dexamethasone appears to reduce mortality, but mortality was still 29% in ventilated patients and 22% in patients on supplemental oxygen who were treated with dexamethasone.
Although this seems to be an exciting development, further examination of the scientific results, when published, will be required to confirm the efficacy of dexamethasone for severe COVID-19. It is likely that dexamethasone operates by reducing inflammation of the lung in severe disease, and thus would not be expected to be useful in the prevention of COVID-19.
The availability of this treatment doesn’t reduce our need to prevent and control community transmission of COVID-19 as the mortality of severe COVID-19.
The cited study [ox.ac.uk]
Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19
ResearchScienceHealthCoronavirus16 June 2020
In March 2020, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) 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.
On 8 June, recruitment to the dexamethasone arm was halted since, in the view of the trial Steering Committee, sufficient patients had been enrolled to establish whether or not the drug had a meaningful benefit.
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.
