Dexamethasone, a synthetic corticosteroid, has been on the market for nearly 60 years and is used to treat an exhaustive number of medical conditions. These include rheumatic conditions such as arthritis, blood/hormone/immune system disorders, allergic reactions, dermatologic conditions, ocular diseases, inflammatory bowel disease, and certain cancers. It is widely available in generic form and inexpensive, and now research suggests that it may improve survival in COVID-19 patients.
Results from the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial, which has been one of the largest efforts to evaluate treating COVID-19 with drugs that are already available and being used or other indications, found that dexamethasone significantly reduced deaths in critically ill patients. The steroid has long been used to treat patients in acute respiratory distress, and in this case, dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65; p=0.0003) and by one fifth in those who were receiving supplemental oxygen only (0.80; p=0.0021). However, no benefit was observed in patients who did not require any type of respiratory support (1.22; p=0.14).
The study was conducted in the United Kingdom (UK) and included 2104 patients who were enrolled from over 175 hospitals operating in the National Health Service (NHS). The patients were randomized to receive dexamethasone 6 mg once per day for a period of 10 days and were compared to 4321 patients who were receiving usual care. In the usual care group, the 28-day mortality was greatest in patients who were ventilated (41%), intermediate in those who need supplemental oxygen only (25%), and lowest for patient not requiring any respiratory support (13%).
These results were released early in a press release, and the researchers note that “given the public health importance of these results, we are now working to publish the full details as soon as possible.”
But even though these results are preliminary, the UK is moving to make dexamethasone the standard of care. The national medical director for the NHS and the chief medical officers of Wales, Scotland, Northern Ireland, and England recommended in a joint statement that clinicians should adjust their practice without waiting for the full publication of the study, “given this clear mortality advantage, with good significance, and with a well-known medicine which is safe under these circumstances.”