How Dexamethasone Increases Coronavirus Covid-19 Patients Survival
According to the Researchers in England, a cheap, widely available steroid called dexamethasone reduced deaths by up to one third in severely ill hospitalized patients. Dexamethasone is the first evidence of a drug that can improve Coronavirus COVID-19 patients survival.
These stunning results were announced Tuesday 16th June 2020. Following the announcement, the British government immediately authorized the drug’s use across the United Kingdom on coronavirus patients so they get well like those who in the study. Researchers vowed to publish results soon, and several independent experts said it’s important to see details to know how much of a difference the drug, dexamethasone, might make and for whom.
The drug, according to BBC News is part of the world’s biggest existing trial treatments for the novel coronavirus. According to the research, “the drug cut the risk of death by a third for patients on ventilators. For those on oxygen, it cut deaths by a fifth.” Hence being referred to as the pandemic’s first ‘lifesaving drug’.
The study, led by the University of Oxford, was a large, strict test that randomly assigned 2,104 patients to get the drug and compared them with 4,321 patients getting only usual care. The drug was given either orally or through an IV for 10 days. After four weeks, it had reduced deaths by 35% in patients who needed treatment with breathing machines and by 20% in those only needing supplemental oxygen. It did not appear to help less ill patients.
Researchers estimated that the drug would prevent one death for every eight patients treated while on breathing machines and one for every 25 patients on extra oxygen alone. But “the bottom line is, good news,” said the United States’ top infectious disease expert, Dr Anthony Fauci. “This is a significant improvement in the available therapeutic options that we have.”
“Those are big effects,” said one study leader, Dr. Martin Landray at Oxford. “It’s not a cure, but it’s certainly a long way forward.” It’s especially good news that the drug “is remarkably cheap, perhaps $20 or $30 for an entire course of treatment,” he added.
Steroid drugs reduce inflammation, which sometimes develops in COVID-19 patients as the immune system overreacts to fight the infection. This overreaction damages the lungs and can prove fatal. The World Health Organization and others advise against using steroids earlier in the course of illness because they can impede clearing the virus.
“Early on, you’re fighting the virus and you want your immune system to be as intact as possible,” Fauci explained. But in the advanced stage of COVID-19, the battle against the virus causes so much inflammation that it “is hurting you more than helping you,” he said. The results seen in the Oxford study make “perfect sense” with that notion, he said.
The dexamethasone research was part of a larger study, called Recovery, that compares a number of potential treatments in an attempt to quickly identify those that are most effective. More than 11,500 patients have been enrolled from over 175 National Health Service hospitals across the U.K.
A number of anti-inflammatories are being studied around the world for helping coronavirus patients cope with a powerful overreaction of the immune system, sometimes called a cytokine storm.
Based on the Oxford study results, dexamethasone would prevent one death by treatment of eight ventilated patients, and around one for every 25 patients requiring oxygen alone, the researchers said. There was no benefit among patients who didn’t need breathing support.
“While this study suggests dexamethasone only benefits severe cases, countless lives will be saved globally,” said Nick Cammack, Covid-19 therapeutics accelerator lead at Wellcome, the medical research philanthropy group.
Countless Lives To be Saved Globally…
Many hospitals and doctors have been trying steroids to quell the immune system, but there’s been no evidence from high-quality studies that it helps for COVID-19.
Until now, the only drug shown to help is remdesivir, an experimental drug from Gilead Sciences that blocks an enzyme the virus uses to copy its genetic material. Remdesivir shortened the time to recovery for severely ill hospitalized patients by 31% to 11 days on average versus 15 days for those just given usual care, in a study led by the U.S. National Institutes of Health.
“We don’t know yet” if remdesivir could be used with dexamethasone or before or after it to give more benefit, Fauci said.
Even though dexamethasone only helps in severe cases, “countless lives will be saved globally,” said Nick Cammack, a virus expert at the Wellcome Trust, a British charity that supports research.
“This is the dream,” because the drug has been used for decades for other conditions, said Cammack, who had no role in the study. “It’s very straightforward to make so there’s no reason this can’t be rolled out for the entire world.”
No information was given on side effects, but researchers said they used a low dose and for a short time, which is generally safe.
Dr. Peter Bach, a health policy expert at Memorial Sloan-Kettering Cancer Center in New York, noted that 41% of those on breathing machines and 25% on oxygen alone died in the study.
“The mortality rate seems to be way higher than it is in the U.S.,” where one recent study found a death rate of 12%, although that was only after two weeks versus four in the UK study, he said.
“We are going to struggle to look at these data and use them for U.S. patients,” he said. But he added that “it’s good news for science that the right studies got done,” and that the drug works and is so affordable and available.
The Oxford study is the same one that earlier this month showed the malaria drug hydroxychloroquine was not working against the coronavirus. The study enrolled more than 11,000 patients in England, Scotland, Wales and Northern Ireland who were given either standard of care or that plus one of several treatments: dexamethasone; hydroxychloroquine; the HIV combo drug lopinavir-ritonavir; the antibiotic azithromycin; the anti-inflammatory drug tocilizumab; or plasma from people who have recovered from COVID-19 that contains antibodies to fight the virus.
Research is continuing on the other treatments. The research is funded by government health agencies in the United Kingdom and private donors including the Bill and Melinda Gates Foundation.
Dr. Stephen Griffin, of the University of Leeds in England, said treatments that can prevent infection and serious illness are still needed.
“Ideally, we will find something that stops the disease from progressing to a more advanced stage,” he said, noting that remdesivir might yet prove to be effective this way. Dexamethasone “is not a wonder pill, but it will lessen some of the nasty effects of COVID-19.”
A Huge Effect in Hospital
Having eight people on ventilators and one not dying is a huge effect size that’s not seen very often in medicine, says Dr. David Juurlink, head of clinical pharmacology at the University of Toronto.
“Since this press release has come out I think it’s going to grab the attention of every hospital-based physician who looks after patients with COVID and I think we’re going to start using it right away,” said Juurlink, who treats patients with COVID-19 in hospital.
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