New Delhi: A corticosteroid used to suppress skin allergies and treat rheumatic disorders has shown promise in the treatment of Covid and has succeeded to significantly reduce mortality risk.
Corticosteroids are a class of hormones secreted by the adrenal gland. Drugs of this class are synthetic copies of these compounds.
The University of Oxford issued a statement Tuesday, highlighting the positive outcome of one arm of the ‘Recovery Trial’ — the dexamethasone arm.
ThePrint takes a look at the drug, its usual usage and the trial.
Dexamethasone is a corticosteroid commonly-used to reduce inflammatory conditions in the body such as allergic disorders and inflammatory bowel disease. It is also used to treat autoimmune disorders such as lupus, rheumatoid arthritis and myasthenia gravis.
While it reduces inflammation, and is a life-saving drug for patients of these diseases, it also tends to suppress the natural immunity of the body, which is why patients are often initiated into it only after they have been tested for opportunistic infections such as tuberculosis.
The chances of the patient catching such an infection during the course of use of the drug are very high. Depression and elevation of blood pressure are among its side-effects.
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The Recovery trial findings
The ‘Recovery Trial’ that is being carried out by Oxford scientists recruited over 11,500 patients in over 175 NHS (National Health Service) hospitals in the UK. The recruitment for the dexamethasone arm stopped on 8 June.
According to the statement by the university: “A total of 2,104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4,321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41 per cent), intermediate in those patients who required oxygen only (25 per cent), and lowest among those who did not require any respiratory intervention (13 per cent).
“Dexamethasone reduced deaths by one-third in ventilated patients… and by one-fifth in other patients receiving oxygen only,” it stated.
Based on these results, one death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone. Overall dexamethasone reduced the 28-day mortality rate by 17 per cent, the statement added.
Peter Horby, professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, and one of the chief investigators for the trial, said: “Dexamethasone is the first drug to be shown to improve survival in Covid-19. This is an extremely welcome result. 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.”
“Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide,” Horby said.
Other arms of the trial
The ‘Recovery Trial’ is one of the biggest trials currently ongoing to look for therapeutic options against Covid-19. It started with six arms — Lopinavir-Ritonavir (commonly used second line drugs to treat HIV), Low-dose Dexamethasone, Hydroxychloroquine (this arm is now stopped), Azithromycin (a commonly used antibiotic), Tocilizumab (an anti-inflammatory treatment given by injection) and Convalescent plasma (collected from donors who have recovered from Covid and contains antibodies against the SARS-CoV-2 virus).
The Lancet study, retracted because of concerns about the quality of data used, had also reached similar conclusions.
India continues to repose its faith in the drug for treatment and prevention of Covid even though the US FDA (Food and Drug Administration) has withdrawn its approval for emergency use of the drug in Covid patients.
Hydroxychloroquine is also a part of the multi-country ‘Solidarity’ trial anchored by the World Health Organization.
The ‘Recovery Trial’ protocol does not exclude participants receiving other treatments for Covid. That is why in a recent note to investigators, the trial managers said patients who are receiving remdesivir, can also be a part of the trial as the drug, touted as one of the most promising therapeutic options against Covid, is not known to interact with any of the drugs being tried in the various arms.
The trial is supported by a grant to the University of Oxford from UK Research and Innovation/National Institute for Health Research (NIHR) and by core funding provided by NIHR Oxford Biomedical Research Centre, Wellcome, the Bill and Melinda Gates Foundation, the Department for International Development, Health Data Research UK, the Medical Research Council Population Health Research Unit, and NIHR Clinical Trials Unit Support Funding.
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