Recovery (Randomised Evaluation of COVID-19 Therapy) is a series of connected clinical trials split across facilities around the world. The trials are testing antivirals, like the Lopinavir-Ritonavir pair used against HIV, antibiotics like azithromycin, and several anti-inflammatory agents. They were also testinghydroxychloroquin, but after finding no positive results, those tests are now closed to new patients and existing tests are winding down.
Among the test being conducted is low doses of corticosteroiddexamethasone. And thats the first of the Recovery tests that seems to have turned up encouraging results.
Dexamethasone is a commonly used, widely available medication. Its used for treating allergies, asthma, rheumatoid arthritis, and just about any situation when inflammation is an issue. Its even used to treat brain swelling following a trauma. Its often used along with chemotherapy.
The drug isnot without side effects. It can cause bruising and muscle weakness and (somewhat perversely in a drug being considered as a disease treatment) can suppress the immune system leading to opportunistic infections. But its been around since the 1960s, is widely used, and its effects on the body are well-understood.
Which makes the results of a randomized trial of over 6,000 patients suffering from serious cases of COVID-19 rather exciting. As the BBC reports,around 2,000 of the patients were given dexamethasone. When their outcomes were compared with those who didnt get the drug, the rate of death decreased by 20%. Among patients who were on ventilators, a dose ofdexamethasone cut the chance of death by a third.
Dropping death rates by a third is a long way from a cure for COVID-19. But it does show that this is a simple, low-cost treatment which is already widely available and which could save thousands of lives. Which is definitely worth celebrating.
This outcome might also suggest further trials, using different dosages and periods of administration, other closely relatedcorticosteroids, and other anti-inflammatory agents. Becausedexamethasone is such a well-understood drug, these results may also be useful in understanding the mechanism by which COVID-19 causes serious illness, helping to lead to additional treatments.
Meanwhile, that FDA warning on hydroxychloroquine indicates that it isnot recommended as it may result in reduced antiviral activity of remdesivir. Remdesivir is also being administered under an Emergency Use Authorization, but unlikehydroxychloroquine the antiviral has demonstrated positiveif limitedresults.
As StatNews reports,remdesivir was most effective for those who were hospitalized but not on a ventilator, where it reduced the median length of hospital stays from 15 days to 11 days. There was also a small decrease in mortality, but considering the size of the study, its not clear if this was statistically significant. However, those on ventilators seemed to fair no better with the drug than without.
Considering that both drugs seemed to have a positive benefit for patients with serious, but not critical, illness, a combination ofdexamethasone andremdesivir could become standard care (assuming there is no negative interaction). And for those in the worst condition,dexamethasoneprovides both a ray of hope for now and a signpost toward other possibilities.