A cheap steroid reduces the risk of dying from coronavirus by a third in patients on ventilators, a major British trial has found.
In the biggest coronavirus breakthrough to date, dexamethasone was also shown to save the lives of a fifth of Covid-19 sufferers with moderate illness receiving oxygen.
The results from the RECOVERY trial suggest the steroid can prevent death in one in eight ventilated coronavirus patients and one in 25 on oxygen.
Dexamethasone, which is given either via an injection or as a once-a-day tablet, becomes the first drug proven to treat the incurable viral disease.
It is commonly prescribed to patients with allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus and psoriasis.
The steroid prevents the release of substances in the body that cause inflammation, a nasty side effect of coronavirus infection that makes breathing difficult.
In seriously unwell Covid-19 patients, the lungs become so damaged they struggle to take in oxygen and keep vital organs functioning.
Scientists behind RECOVERY, led by Oxford University, are recommending all 400 coronavirus patients currently intubated in NHS hospitals are prescribed the drug.
Professor Martin Landray, lead author of the study, said dexamethasone could have saved around 5,000 lives if it was used throughout the UK’s crisis.
He hailed today’s finding as the biggest breakthrough so far in the search for a Covid-19 treatment, adding: ‘If you were to design a drug that treats coronavirus, this would be exactly how you’d hope it works.’
The RECOVERY trial has recruited more than 11,500 Covid-19 patients from 170 NHS hospitals across the country.
A total of 2,104 patients were randomised to receive 6mg of dexamethasone once per day, either by mouth or by intravenous injection for 10 days.
They were compared with 4,321 patients randomised to receive standard care alone, which involves painkillers and in some cases antibiotics.
Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41 per cent).
In patients who required oxygen, a quarter passed away, while 13 per cent of sufferers who did not need any breathing assistance also died.
Dexamethasone reduced deaths by one-third in ventilated patients and by one fifth in other patients on breathing support. There was no benefit among patients who did not require oxygen.
Co-lead study author Peter Horby, professor of emerging infectious diseases at Oxford, said: ‘Dexamethasone is the first drug to be shown to improve survival in COVID-19. 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.’
Professor Landray, an epidemiologist at Oxford, added: ‘Since the appearance of Covid-19 six months ago, the search has been on for treatments that can improve survival, particularly in the sickest patients.
‘These preliminary results from the RECOVERY trial are very clear – dexamethasone reduces the risk of death among patients with severe respiratory complications.
‘Covid-19 is a global disease – it is fantastic that the first treatment demonstrated to reduce mortality is one that is instantly available and affordable worldwide.’
Health bosses hailed the results as a ‘huge breakthrough’ which will ‘dramatically improve Covid-19 survival’ for patients in the UK.
NHS chief executive Simon Stevens said: ‘NHS hospitals, researchers and clinicians have worked together at breakneck speed to test new treatments for covid-19, and it is amazing to see work that would normally take years bear fruit in just a matter of months.
‘This research agility is not only important for coronavirus patients, but augurs well for the streamlined innovation that the NHS and the UK life sciences now must pioneer.’
Professor Stephen Powis, NHS medical director, added: ‘This is a huge breakthrough in our search for new ways to successfully treat patients with Covid, both in the UK and across the world.
‘It is thanks to NHS staff and patients who participated in the trial that from now, we are able to use this drug to dramatically improve Covid-19 survival for people in hospital who require oxygen or ventilation.’
Dr Nick Cammack, head of the research-charity Wellcome Trust, which is conducting its own studies into Covid-19 therapies, added: ‘This is a major breakthrough: dexamethasone is the first and only drug that has made a significant difference to patient mortality for Covid-19.
‘Potentially preventing 1 death in every 8 ventilated patients would be remarkable. Finding effective treatments like this will transform the impact of the Covid-19 pandemic on lives and economies across the world.
‘While this study suggests dexamethasone only benefits severe cases, countless lives will be saved globally.
‘Dexamethasone must now be rolled out and accessed by thousands of critically ill patients around the world. It is highly affordable, easy to make, can be scaled up quickly and only needs a small dosage.
Any and every successful treatment against Covid-19 must be made available to everyone who needs it globally, regardless of their ability to pay.’
Earlier this month the RECOVERY trial found the promising anti-malaria drug hydroxychloroquine does not treat coronavirus.
A total of 1,542 patients were randomly given hydroxychloroquine and compared with 3,132 patients randomised to receive standard care in the Oxford trial.
After 28 days, 25.7 per cent of patients taking the malaria tablets passed away from the virus compared to 23.5 per cent who were not given the medicine.
Dexamethasone and hydroxychloroquine are just two of five promising therapies being trialled as part of the RECOVERY study.
Participants are also being given the HIV drug lopinavir/ritonavir, marketed as Kaletra and Aluvia; azithromycin, a commonly used antibiotic; and tocilizumab, an anti-inflammatory given by injection.
Professor Landray had previously admitted he did not expect one single drug to treat coronavirus.
Just two months ago he said there was an ‘extraordinarily’ low chance of one of the five medicines being effective on its own and claimed it was more likely a combination of several drugs will have ‘modest effect’ on patients.
