Scientists hail breakthrough as dexamethasone found to reduce deaths by one-third in ventilated patients
UK scientists have hailed the biggest Covid-19 drug breakthrough to date after an Oxford university trial found a cheap and widely available generic steroid significantly reduced the risk of dying from coronavirus.
The drug, dexamethasone, was found to cut the death rate of the most seriously ill patients on ventilators by one-third, and by one-fifth in patients receiving oxygen, according to trial results announced on Tuesday. “This is a statistically compelling result” with “instant global importance” said Martin Landray, an Oxford professor of medicine and epidemiology and deputy chief investigator of the so-called Recovery trial. “It works for the sickest patients, which is exactly what one would hope for.” “It will save lives and it will do so at a remarkably low cost,” he added, estimating that up to 5,000 fewer people would have died from the virus in the UK alone if dexamethasone had been used from the start of the crisis. Boris Johnson, the UK prime minister who has faced mounting pressure over his government’s handling of the pandemic, used the daily Covid-19 briefing to trumpet “the biggest breakthrough yet” on treating the virus. “I am proud of these British scientists, backed by UK government funding, who have made the first robust clinical trial anywhere in the world to find a coronavirus treatment proven to reduce the risk of death,” he said.
Dexamethasone, which was first developed in the 1950s, is inexpensive and readily available in most countries. The off-patent treatment — commonly used to treat skin disease, arthritis and bowel disorders — costs roughly £5 in the UK and as little as $1 in countries such as India. Pharmaceutical companies, governments and academic institutions have been racing to develop treatments for a virus that has created the biggest economic and health crisis in living memory.
There has been huge interest in trials of a range of drugs such as hydroxychloroquine, a malaria treatment, and remdesivir, an antiviral medication developed by California-based Gilead Sciences.
The researchers running the Recovery trial, the world’s largest randomised trial of Covid-19 treatments, concluded two weeks ago that there was “no beneficial effect of hydroxychloroquine in patients hospitalised with Covid-19”. With dexamethasone, however, they found that it prevented one in eight ventilated patient deaths and one in 25 deaths of patients requiring oxygen. The trial found no benefit among those who were not receiving ventilation or oxygen support. The drug reduced the total 28-day virus mortality rate by 17 per cent.
Chris Whitty, England’s chief medical officer, said the dexamethasone study was “the most important trial result for Covid-19 so far”. “Significant reduction in mortality in those requiring oxygen or ventilation from a widely available, safe and well-known drug . . . It will save lives around the world,” he wrote on Twitter.
The UK government, which has invested more than £2m in the Recovery trial, had enough stockpiles of dexamethasone to treat more than 200,000 people, it said, and had added the drug to its “parallel export list”, which bans individuals from exporting or hoarding it. Patrick Vallance, the UK government’s chief scientific adviser, called the trial a “groundbreaking development in our fight against the disease”, adding: “It is particularly exciting as this is an inexpensive widely available medicine.” It is too early to say why exactly the trial showed success in the use of dexamethasone but it could be that steroids help seriously ill patients by reducing inflammation in the lungs, enabling them to recover. Some commentators poured cold water on the Oxford trial, saying that celebrations should be reserved until the full study and its underlying data had been published.
“It will be great news if dexamethasone . . . really does cut deaths by 1/3 in ventilated patients with Covid-19, but after all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper,” wrote Atul Gawande, a US-based surgeon and writer. As part of the Recovery trial, a total of 2,104 patients received a low dose of dexamethasone once per day, either by mouth or intravenous injection, for 10 days in a randomised control trial, compared with 4,321 patients who did not receive the steroid.
Additional reporting by Jim Pickard in London and source FT