Dexamethasone: low-cost drug helps prevent deaths of sickest coronavirus patients

A cheap steroid has become the first life-saving treatment in the Covid-19 pandemic, described by scientists as “a major breakthrough” and raising hopes for the survival of thousands of the most seriously ill.

Dexamethasone is available from any pharmacy, and easily obtainable anywhere in the world. Investigators said the drug was responsible for the survival of one in eight of the sickest patients – those who were on ventilators – in the Recovery trial, the biggest randomised, controlled trial of coronavirus treatments in the world.

The government announced immediate approval for the use of the drug in Covid-19 patients. The UK was leading the way, said the health secretary, Matt Hancock. “This astounding breakthrough is testament to the incredible work being done by our scientists behind the scenes.

“From today the standard treatment for Covid-19 will include dexamethasone, helping save thousands of lives while we deal with this terrible virus.”

Boris Johnson hailed the successful trial at Tuesday’s Downing Street press conference. “Today, there is genuine cause to celebrate a remarkable British scientific achievement, and the benefits it will bring, not just in this country but around the world,” the prime minister said.

“This drug, dexamethasone, can now be made available across the NHS, and we’ve taken steps to ensure we have enough supplies, even in the event of a second peak.”

However, he said death rates from the disease remained “far too high: so we must redouble our research efforts, and we certainly will.”

Hancock spoke within hours of the Oxford University investigators announcing their findings, which they said were definitive. Dexamethasone reduced deaths among patients on ventilators by up to one-third and among those on other oxygen support by one-fifth.

“It is the only drug so far shown to reduce mortality and it reduces it significantly,” said Peter Horby, a professor of emerging infectious diseases in the Nuffield department of medicine at the University of Oxford, and one of the chief investigators of the trial. “It is a major breakthrough, I think.”

Prof Martin Landray, his co-chief investigator, said the sickest patients could begin to be treated with the drug immediately, anywhere in the world. “The search has been on for a treatment that actually reduces the risk of dying. There hasn’t been one until today.

“This is a drug that is globally available. This is not an expensive drug. That is immensely important.”

Dexamethasone was one of the first drugs to be included in Recovery, the biggest randomised controlled study of drugs against Covid-19 in the world, which has now recruited more than 11,500 patients from 176 hospitals across the whole of the UK. It was chosen because it works against inflammation, including in the lungs, and is cheap, known to be safe in low doses and widely available.

A total of 2,104 patients were chosen at random to receive 6mg of dexamethasone once a day (either by mouth or by intravenous injection) for 10 days. Their outcomes were compared with 4,321 patients chosen at random to continue with normal care alone.

Without the drug, death rates at 28 days were highest in those who needed to be put on a ventilator (41%), intermediate in those who required oxygen only (25%), and lowest among those whose lungs were working sufficiently well (13%).

Dexamethasone reduced deaths by one-third in ventilated patients and by one-fifth in other patients receiving oxygen only. There was no benefit among those patients who did not need help to breathe.

Landray said there was no room for doubt. “This is not the play of chance. This is a completely compelling result,” he said. “If one treated around eight ventilated patients, one patient would survive because of that treatment who would not have survived if you hadn’t given that treatment.”

Among those needing oxygen, one life would be saved for every 25 patients treated, he said. “If you put that in the scale of the UK epidemic over the last few months, the difference dexamethasone [would have made] is around 4,000 or 5,000 lives and clearly the epidemic is an international issue.

“This is a result of instant global importance because this drug is readily available. It’s been around for probably 60 years, it costs in the order of £5 for a complete course of treatment in the NHS and substantially less – probably less than $1 – in other parts of the world, for example in India.”

Last week, the Recovery team, who have been trialling seven drugs and will add more, concluded that hydroxychloroquine did not benefit patients in hospital with Covid-19. That result has also had global impact, with first the US regulator, the Food and Drug Administration, revoking the drug’s emergency authorisation and then its UK counterpart, the Medicines and Healthcare products Regulatory Authority, suspending any further patient trials.

Other scientists agreed the dexamethasone result was a breakthrough. Sir Patrick Vallance, the government’s chief scientific adviser, said: “This is tremendous news today from the Recovery trial showing that dexamethasone is the first drug to reduce mortality from Covid-19. It is particularly exciting as this is an inexpensive, widely available medicine.

“This is a groundbreaking development in our fight against the disease, and the speed at which researchers have progressed finding an effective treatment is truly remarkable. It shows the importance of doing high-quality clinical trials and basing decisions on the results of those trials.”

The NHS chief executive for England, Simon Stevens, said: “NHS hospitals, researchers and clinicians have worked together at breakneck speed to test new treatments for Covid-19, and it is amazing to see work that would normally take years bear fruit in just a matter of months.”

Prof Stephen Powis, NHS medical director for England, said it was “a huge breakthrough in our search for new ways to successfully treat patients with covid, both in the UK and across the world.

“It is thanks to NHS staff and patients who participated in the trial that from now, we are able to use this drug to dramatically improve Covid-19 survival for people in hospital who require oxygen or ventilation.”

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