Preliminary RECOVERY study results show mortality reduction for those requiring respiratory support

Dexamethasone appears to be beneficial for severely ill Covid-19 patients, according to results from the RECOVERY (Randomized Evaluation of COVid-19 thERapY) trial, which is testing a number of potential treatments for the illness.

In the trial, 2,104 patients were randomized to receive oral or injected dexamethasone 6 mg once daily for 10 days. These patients were compared with 4,321 patients who received usual care. In the usual care arm, at 28 days, 41% of those patients on mechanical ventilation died, there was a 25% mortality rate in those who required oxygen, and there was a 13% mortality rate in those who did not require any respiratory interventions.

“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),” the researchers reported in a statement.

“Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone,” they wrote.

These results have not yet been published in a peer-reviewed journal, but the researchers noted they are working to do this as soon as possible.

This study result is notable as early on in the pandemic, researchers writing in the Lancet — and reported by BreakingMEDadvised against corticosteroid use. That advice was based on experience during two earlier coronavirus epidemics — the SARS-CoV-1 and MERS-CoV — when several studies failed to show benefit for corticosteroids but did find adverse outcomes that included patients requiring mechanical ventilation, developing corticosteroid-induced diabetes or SARS-related psychosis, and increased mortality.

Nonetheless, these latest results for dexamethasone in Covid-19 patients could make it one of the first promising therapies for the sickest of the sick patients.

“Dexamethasone is the first drug to be shown to improve survival in Covid-19,” said Peter Horby, Professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, and one of the Chief Investigators for the trial. “This is an extremely welcome result. The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”

The RECOVERY trial has randomized more than 11,500 patients to a treatment arm, or standard care. Along with dexamethasone, the researchers are studying:

  • Lopinavir-Ritonavir.
  • Hydroxychloroquine (which has now been stopped due to lack of efficacy).
  • Azithromycin.
  • Tocilizumab.
  • Convalescent plasma.

Candace Hoffmann, Managing Editor, BreakingMED™

Cat ID: 190

Topic ID: 79,190,254,930,500,932,570,730,933,190,520,926,192,927,151,928,925,934