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Landmark UK trial: Steroid treatment saves 1/3 of most severe COVID-19 cases

Researchers in England say they have the first evidence that a drug can improve COVID-19 survival: A steroid called dexamethasone reduced deaths by up to one third in severely ill hospitalized patients.

Results were announced Tuesday and researchers said they would publish them soon. The study is a large, strict test that randomly assigned 2,104 patients to get the drug and compared them with 4,321 patients getting only usual care.

The drug was given either orally or through an IV.

It reduced deaths by 35% in patients who needed treatment with breathing machines and by 20% in those only needing supplemental oxygen. It did not appear to help less ill patients.

“This is an extremely welcome result,” one study leader, Peter Horby of the University of Oxford, said in a statement. “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.”

This is the same study that earlier this month showed the malaria drug hydroxychloroquine was not working against the coronavirus.

The study enrolled more than 11,000 patients in England, Scotland, Wales and Northern Ireland who were given either standard of care or that plus one of several treatments: the HIV combo drug lopinavir-ritonavir, the antibiotic azithromycin; the steroid dexamethasone, the anti-inflammatory drug tocilizumab, or plasma from people who have recovered from COVID-19 that contains antibodies to fight the virus.

Following the research announcement, British Health Secretary Matt Hancock said Tuesday the UK would start administering dexamthasone to COVID-19 patients.

“We’re working with the NHS (National Health Service) so that the NHS standard treatment for COVID-19 will include dexamethasone form this afternoon,” Hancock said.

Hancock said the government had started stockpiling dexamethasone back in March after preliminary trials showed “early signs” of the drug’s potential.

A ‘major breakthrough’

The trial results are particularly promising as around 40 percent of COVID-19 patients who require a ventilator end up dying, often because of the body’s uncontrolled inflammatory response to the virus.

“This is a major breakthrough: dexamethasone is the first and only drug that has made a significant difference to patient mortality for COVID-19,” said Nick Cammack, COVID-19 Therapeutics Accelerator Lead at the Wellcome Trust health charity.

The trial showed dexamethasone to be ineffective in treating patients with milder forms of COVID-19, however.

A number of existing drugs have been trialed as a treatment against the novel coronavirus, with mixed results.

Trials of treatment of anti-arthritis drug hydroxychloroquine were halted in several countries after a major study in The Lancet medical journal suggested it showed no benefit among COVID-19 patients and even increased the risk of death.

That study has since been retracted.

Remdesivir, an anti-viral that appears to reduce the length of treatment in some patients is already being used in Britain, but one study in April showed it had “no clinical benefit.”

The fact that an existing, cheap and largely side-effect free medication has been shown to be effective in severe COVID-19 cases is “of tremendous importance,” according to Stephen Griffin, associate professor in the School of Medicine, University of Leeds.

“There is (now) realistic scope for further improving the clinical management of this devastating disease,” said Griffin, who was not involved in the study.

Research is continuing on the other treatments.

The research is funded by government health agencies in the United Kingdom and private donors including the Bill and Melinda Gates Foundation.

Source: AGENCIES via TOI