Study shows first evidence that a drug can improve survival from COVID-19

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

"This is an extremely welcome result," said one study leader, Peter Horby of the University of Oxford, 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."

Even though the drug only helps in severe cases, "countless lives will be saved globally," said Nick Cammack of Wellcome, a British charity that supports science research.

"Dexamethasone must now be rolled out and accessed by thousands of critically ill patients around the world," said Cammack, who had no role in the study. "It is highly affordable, easy to make, can be scaled up quickly and only needs a small dosage."

Steroid drugs reduce inflammation, which sometimes develops in COVID-19 patients as the immune system overreacts to fight the infection. This overreaction can prove fatal, so doctors have been testing steroids and other anti-inflammatory drugs in such patients.

There are currently no approved treatments or vaccines for COVID-19, the disease caused by the novel coronavirus that has killed more than 431,000 people globally.

The World Health Organization advises against using steroids earlier in the course of illness, because they can slow the time until patients clear the virus.

Researchers estimated that the drug would prevent one death for every eight patients treated while on breathing machines and one for every 25 patients on extra oxygen alone.

Huge effect in hospital

Having eight people on ventilators and one not dying is a huge effect size that's not seen very often in medicine, says Dr. David Juurlink, head of clinical pharmacology at the University of Toronto.

"Since this press release has come out I think it's going to grab the attention of every hospital-based physician who looks after patients with COVID and I think we're going to start using it right away," said Juurlink, who treats patients with COVID-19 in hospital.

WATCH | Canada will 'look with great interest' at dexamethasone:

Dr. Tam says Canada is closely watching research into steroid's effect on COVID-19

4 years ago

Duration 0:58

Dr. Theresa Tam, Canada's chief public health officer, says Canada will "look with great interest" and closely examine the results from trials of the steroid dexamethasone as a treatment for COVID-19. Researchers in England say that they have evidence the drug can reduce deaths by up to one-third in severely ill hospitalized patients.

Juurlink says he suspects the drug helps reduce inflammation in the lungs and allows better exchange of oxygen. 

Dr. Todd Lee, a physician at the McGill University Health Centre in Montreal who researches infectious diseases, also says the differences in mortality seem substantial. While Lee awaits the published details, he agrees patients who need oxygen, as in the trial, who face minimal risks, should receive dexamethasone.

"It's very hard to practice medicine from press release," Lee cautioned. 

Rigorous trial

Potential side-effects, such as destruction of joints, might be justified to save lives of people seriously sick with COVID-19 in hospital, he said. 

It's a different story for people who test positive for COVID-19 and are recovering at home. "If we're talking about feeling better two days sooner and you're going to live with — permanently live with — this destruction of one of your joints, well that's probably not a trade that most people would take," Lee said.

The Public Health Agency of Canada says those who are infected with COVID-19 may have little to no symptoms. Most people with mild illness will recover on their own.

Among patients with COVID-19 who did not require respiratory support, there was no benefit from treatment with dexamethasone.

Dr. Theresa Tam, Canada's chief public health officer, said officials would like to examine the trial results when published. "I think as we've seen with many treatments being proposed in the course of learning about this new virus it's very important for us to actually examine the results very carefully before making any further recommendations," Tam said.

This is the same study, known as the RECOVERY trial, 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 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.
• Plasma from people who have recovered from COVID-19 that contains antibodies to fight the virus.

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.