Steroid shows promise in COVID-19 survival
Researchers in England say they have the first evidence that a drug can improve COVID-19 survival: A cheap, widely available steroid reduced deaths by up to one third in severely ill hospitalized patients.
The results were announced Tuesday and the British government immediately authorized the drug’s use across the United Kingdom for coronavirus patients like those who did well in the study. Researchers said they would publish results soon, and several independent experts said it’s important to see details to know how much of a difference the drug, dexamethasone, might make and for whom.
But “bottom line is, good news,” said the United States’ top infectious disease expert, Dr. Anthony Fauci. “This is a significant improvement in the available therapeutic options that we have.”
The study, led by the University of Oxford, was 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 for 10 days. After four weeks, it had 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.
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.
“Those are big effects,” said one study leader, Dr. Martin Landray at Oxford. “It’s not a cure, but it’s certainly a long way forward.” It’s especially good news that the drug “is remarkably cheap, perhaps $20 or $30 for an entire course of treatment,” he added.
Steroid drugs reduce inflammation, which sometimes develops in COVID-19 patients as the immune system overreacts to fight the infection. This overreaction damages the lungs and can prove fatal. The World Health Organization and others advise against using steroids earlier in the course of illness because they can impede clearing the virus.
“Early on, you’re fighting the virus and you want your immune system to be as intact as possible,” Fauci explained. But in the advanced stage of COVID-19, the battle against the virus causes so much inflammation that it “is hurting you more than helping you,” he said. The results seen in the Oxford study make “perfect sense” with that notion, he said.
Many hospitals and doctors have been trying steroids to quell the immune system, but there’s been no evidence from high-quality studies that it helps for COVID-19.
Until now, the only drug shown to help is remdesivir, an experimental drug from Gilead Sciences that blocks an enzyme the virus uses to copy its genetic material. Remdesivir shortened the time to recovery for severely ill hospitalized patients by 31% to 11 days on average versus 15 days for those just given usual care, in a study led by the U.S. National Institutes of Health.