Breakthrough in COVID-19 treatment with Dexamethasone
The NIHR-funded and supported study RECOVERY (Randomised Evaluation of COVid-19 thERapY) has today announced that the steroid dexamethasone has been identified as the first drug to improve survival rates in certain coronavirus patients.
RECOVERY was established in March 2020 as a randomised clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a corticosteroid). As an urgent public health study, the trial has been prioritised for delivery across the UK by the NIHR. Through the NIHR’s Clinical Research Network, over 11,500 patients have so far been enrolled into RECOVERY from over 175 NHS hospitals in the UK.
A total of 2104 patients were randomised to dexamethasone once per day for ten days and were compared with 4321 patients randomised to usual care alone. Among the usual care control group, 28-day mortality was highest in those on ventilators (41%), intermediate in those on oxygen only (25%), and lowest among those who were not receiving any respiratory intervention (13%).
The study, conducted at the University of Oxford and led by Professor Peter Horby and Professor Martin Landray, found that dexamethasone reduced the risk of dying by one-third in ventilated patients and by one fifth in other patients receiving oxygen only.
There was no benefit among those who did not need respiratory intervention.
Overall, dexamethasone reduced the risk of 28-day mortality by 17% with a highly significant trend showing greatest benefit among those on ventilators. No evidence of benefit was found for patients who did not receive oxygen and the study did not include patients outside the hospital setting. Follow-up is complete for over 90% of participants.
Prof Chris Whitty, Chief Medical Officer for England and co-leader of the NIHR said:
"This is the most important trial result for COVID-19 so far. Is shows significant reduction in mortality in those requiring oxygen or ventilation from a widely available, safe and well known drug. We should all be grateful to the patients who volunteered and those who made this trial possible. It will save lives around the world.”
Prof Nick Lemoine, Chair of the NIHR's Urgent Public Health group and Medical Director of the NIHR's Clinical Research Network, said:
"This is hugely promising news from a world-leading team of researchers. Once again, this shows how UK research is truly at the forefront of the fight against the coronavirus, and how the NIHR's unique funding, support and delivery model leads to meaningful breakthroughs in unprecedented time-frames."
The RECOVERY Trial is a large, randomised controlled trial of possible treatments for patients admitted to hospital with COVID-19. Over 11,500 patients have been randomised to the following treatment arms, or no additional treatment:
• Lopinavir-Ritonavir (commonly used to treat HIV)
• Low-dose Dexamethasone (a type of steroid, which typically used to reduce inflammation)
• Hydroxychloroquine (which has now been stopped due to lack of efficacy)
• Azithromycin (a commonly used antibiotic)
• Tocilizumab (an anti-inflammatory treatment given by injection)
• Convalescent plasma (collected from donors who have recovered from COVID-19 and contains antibodies against the SARS-CoV-2 virus).