Dexamethasone Demonstrates Strong Results for COVID-19

Peter Horby, MD, PhD

The original article, “Dexamethasone Reduces Death by 35% in Patients with COVID-19 Respiratory Complications,” was published online on ContagionLive,

Findings of a new study suggest dexamethasone reduces deaths by one-third in ventilated patients and by one-fifth in patients with coronavirus disease 2019 (COVID-19) who are receiving oxygen.

Investigators of the “Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial,” a UK-based, randomized trial compared the therapy to patients randomized to usual care (control group). The team had 2104 patients receiving dexamethasone 6 mg once daily for 10 days and 4321 patients in the control group.

It was reported that patients on dexamethasone saw a 35% reduction in deaths (rate ratio [RR], 0.65; 95% CI, 0.48-0.88; P = .0003) versus usual care. Treated patients receiving oxygen reported a 20% reduction in deaths (RR, 0.80; 95% CI, 0.67-0.96; P = .0021).

Among the patients who received only usual care, the 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).

No benefit was seen in patients who did not require respiratory support (RR, 1.22; 95% CI, 0.86-1.75]; P = .14).

Based on these results, 1 death would be prevented by treatment of approximately 8 ventilated patients, or 25 patients requiring oxygen alone.

Co-chief investigator Peter Horby, MD, PhD, professor, Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, talked about the fact that this is not only the first drug to improve the survival rate in these sicker COVID-19 patients but touted its other benefits as well.

“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,” Horby said. “Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.”