Cheap drug shown to improve survival odds
Steroid reduces death rates by 35%, British announce Tuesday
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 such as those who did well in the study. Researchers said they would publish results soon in a medical journal, 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 coronavirus outbreak has killed more than 438,000 people worldwide since it began late last year in China.
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 highquality studies that it helps for COVID-19.
Although the Oxford researchers talked only about dexamethasone, the detailed plans for the study say that participating hospitals could use two other steroids — prednisolone or hydrocortisone — and there’s no reason to think any particular one works better than another, said Dr. Francisco Marty, an infectious disease specialist at Brigham and Women’s Hospital in Boston.
“I assume the majority of people used dexamethasone, but it’s not the only one that people could have used,” he said. “It will be great to see the data to see if there’s a class effect.”
Steroids are known to help fight certain fungal and bacterial infections such as meningitis, and a type of pneumonia common in HIV patients, but they have not proved useful against flu or some other viral diseases, he said.