A breakthrough in the fight against coronavirus: dexamethasone saves lives (Nature, UK)

Inexpensive and widely used steroid is able to save the lives of people seriously ill covid-19. This conclusion was made based on the results of clinical trials conducted in Britain. The drug called dexamethasone, and testing has shown that this is the first drug that reduces deaths from coronavirus, which has killed more than 430 000 people worldwide. According to the study, the risk of mortality of infected patients on mechanical ventilation is reduced by about a third.

“This is a remarkable result, — said the doctor-resuscitator, Kenneth Bailey (Kenneth Baillie), working at the University of Edinburgh and is included in the composition of the coordination Committee for testing called RECOVERY (Recovery). — This is obviously going to have huge global consequences.” The authors of the study announced its results in a press release published on June 16. But scientists say they intend as soon as possible to publish the results of the study, and that they already talked about their findings to the regulators in the UK and in other countries.

Launched in March test RECOVERY are the world’s largest randomized controlled trials from the coronavirus. The study was checked several possible drugs. The research drew 2 100 patients who received dexamethasone for 10 days in small or moderate doses at six milligrams a day. Then their condition compared with 4 300 patients who were treated from coronavirus infection by standard means.

Most striking was the effect of dexamethasone to critically ill patients who were on mechanical ventilation. Patients on oxygen treatment, but without the ventilator condition is also improved. The risk of mortality, they have decreased by 20%. This drug does not have any impact on people with mild disease covid-19. Patients who did not receive oxygen treatment and which were not on a ventilator.

Shortly after the announcement, the British government declared that it would immediately give the indication to the treatment of dexamethasone hospitalized with covid-19 patients requiring oxygen, including ventilators.

Meticulous research

“This is a major breakthrough,” says Peter Horby (Peter Horby), working as an infectious diseases doctor at Oxford University and participated in trials as a principal investigator. He notes that the use of steroids for the treatment of respiratory viral infections such as covid-19, arguable. Test data of steroids during outbreaks of atypical pneumonia (SARS) and middle East respiratory syndrome caused by similar coronaviruses, was inconclusive, says Horby. However, because dexamethasone is publicly available, and steroids test during previous outbreaks have given promising results, participants in the study found it necessary to test the drug in the course of thorough clinical tests.

The world health organization and many countries in their treatment instructions warn that infected with coronavirus, people should not be treated with steroids. Some researchers were concerned by reports of individual cases, the wide use of steroids. These drugs suppress the immune system, which eases the suffering of patients whose lungs are affected by the excessive immune reaction that sometimes occurs in severe cases covid-19. However, such patients still need a healthy immune system to fight the virus itself.

The tests indicate that at the tested doses, the benefits of steroid treatment outweighs the possible harm. The researchers found no noticeable side effects and complications from this medication. “This drug can be given to almost everyone,” says Horby.

As for the selectivity of its effect (best results in severely ill patients and no effect in mild infection), it is consistent with the notion that a hyperactive immune response causes more damage in case of prolonged and serious infection. This is evidenced by Anthony Fauci (Anthony Fauci), who heads the us national Institute of allergic and infectious diseases. “When you are seriously ill and are on a ventilator, you have usually occurs abnormal or overactive inflammatory response, which contributes to mortality in the same extent and direct viral effects”.

“The search and discovery of effective medicines like this will change the nature of the impact of the pandemic covid-19 on the lives of people and economies around the world, noted in his statement, Nick Cammack (Nick Cammack), working in London at a nonprofit biomedical research Wellcome and head of the treatment program covid-19. — This study showed that dexamethasone helps only in severe cases, however, it will save a great many lives worldwide.”

Today there’s only a single drug that helps patients covid-19. Is an antiviral drug ramdevpir. It proved its effectiveness during a large-scale clinical trials. Ramdevpir reduces the time of treatment of patients in the hospital, but according to statistics, it does not reduce significantly the mortality rate.

Ramdevpir is also a scarce drug. The manufacturer, biopharmaceutical company Gilead Sciences with headquarters in foster city, California, has already taken steps to increase production, but at present this medication is available only in few hospitals in different countries of the world. In addition, ramdevpir is introduced by injection, and this is done within a few days.

In contrast, dexamethasone is widely distributed and is on the shelves in all pharmacies of the world. In addition, this tablet, which is especially advantageous because of the incidence of coronavirus continues to rise in countries where access to health care is limited. “In less than 50 pounds can be cured and eight patients to save one life,” says the epidemiologist from the University of Oxford Martin Landray (Martin Landray), who also took part in the study.

The results of the tests can also have serious consequences for the treatment of other severe respiratory diseases, said Bailey. For example, steroid treatment of acute respiratory distress syndrome, also causes serious doubts. “But we have good reason to take a closer look at this, because there are obvious benefits in terms of mortality decline, Bailey said. — I think it will benefit not only patients covid-19”.