A cheap steroid cuts deaths from severe covid-19

DRUG DISCOVERY is, almost by definition, an emotional rollercoaster. The path to success is strewn with false hopes, disappointment and even the occasional scientific scandal. And so it has been with the search for a medicine to treat patients dying from covid-19.

But the gloom lifted on June 16th with news from a large clinical trial in Britain. This trial found that dexamethasone, a cheap steroid drug, reduced deaths by a third among the most severely ill covid-19 patients. The drug is set to become the standard of care for the National Health Service (NHS) across Britain. Doctors around the world will, undoubtedly, follow suit.

The dexamethasone study was conducted as part of a larger trial by the NHS and the University of Oxford called RECOVERY (Randomised Evaluation of COVid-19 thERapY), which is testing a range of drugs for covid-19 patients in 176 hospitals—-and is the world’s largest clinical trial of covid-19 drugs. Dexamethasone is an anti-inflammatory that is already used to treat a variety of health problems, including rheumatoid arthritis, eczema, asthma and some cancers. Steroids were tried as a treatment for SARS (severe acute respiratory syndrome), a respiratory disease related to covid-19, with mixed results.

As part of the British trial 2,104 patients were randomly assigned to receive dexamethasone either orally or by injection. They were compared with 4,321 patients who received the usual standard of care alone; that includes treatment for dehydration and pre-existing health problems, plus oxygen or a ventilator if needed. Among those who received only the usual care, 41% of patients ill enough to need ventilators died within 28 days; so did 25% of those on only supplemental oxygen and 13% of those who did not need help to breathe. For patients treated with dexamethasone, the 28-day death rate was 28% for those on ventilators and 20% for those on oxygen. There was no benefit from the drug for the rest.

This is big. If doctors in Britain had known from the start what they know now about the effectiveness of dexamethasone, they could have saved 4,000-5,000 lives since the country’s covid-19 epidemic began. That is roughly 10% of the number of people who have died from the illness in Britain.

Dexamethasone can be put to immediate use for covid-19 patients anywhere in the world. It is a generic drug that hospital pharmacies usually have on their shelves. A course of treatment costs the NHS about £5 ($6.30). In poor countries it would cost about $1. As the pandemic gathers speed, a well-known medicine that is cheap and widely available around the world is a bright light in what is still a long, dark tunnel.■

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