Dexamethasone in the Treatment of COVID-19
THE RECOVERY TRIAL
News emerged from the UK on June 16 around very promising results with dexamethasone in the treatment of COVID-19 infected patients in the Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial. RECOVERY is a randomized trial investigating whether treatment with either (1)Lopinavir-Ritonavir, (2)Hydroxychloroquine, (3)Corticosteroids, (4)Azithromycin,(5) Convalescent plasma or (6)Tocilizumab prevents death in patients with COVID-19.
2104 patients were randomized to receive dexamethasone 6 mg once per day (orally or via IV) x 10 days and were compared with 4321 patients randomized to usual care.
In the usual care group, 28-day mortality was
- 41% in those who required ventilation
- 25% in those patients who required oxygen only
- 13% among those who did not require any respiratory intervention
Dexamethasone reduced deaths by one-third in ventilator-dependent patients (rate ratio 0.65 [95% CI 0.48 to 0.88]; p=0.0003), by one fifth in patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14).
FULL PEER-REVIEWED PUBLICATION PENDING
Given the significance of these results, investigators are working to publish the full details as soon as possible. This news is especially positive in that dexamethasone is widely available, and that the greatest benefit was seen in the sickest patients.
In related news, it was announced on June 5 that enrollment in the hydroxychloroquine was stopped when investigators concluded that there was no beneficial effect of in patients hospitalized with COVID-19.