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Statnews.com: Major Study, not published yet, indicates dexamethasone reduces death rate from COVID-19 in ventilator patients by 35%

2020-06-16

Coronavirus studies by Engin Akyurt via pixabay.com

Statnews.com reported on June 16 that a study found dexamethasone (6 mg once a day, oral or intravenous) improved survival in severe COVID-19: “‘Dexamethasone is the first drug to be shown to improve survival in COVID-19,’ Peter Horby, one of the lead investigators of the study and a professor in the Nuffield Department of Medicine at the University of Oxford, said in a statement.”

From the statnews report:

The study randomly assigned 2,104 patients to receive six milligrams of dexamethasone once a day, by mouth or intravenous injection. These were compared to 4,321 patients assigned to receive usual care alone.

In patients who needed to be on a ventilator, dexamethasone reduced the death rate by 35%, meaning that doctors would prevent one death by treating eight ventilated patients. In those who needed oxygen but were not ventilated, the death rate was reduced 20%, meaning doctors would need to treat 25 patients to save one life. Both results were statistically significant.

There was no benefit in patients who didn’t require any oxygen. The researchers running the study, called RECOVERY, decided to stop enrolling patients on dexamethasone on June 8 because they believed they had enough data to get a clear result.

Dexamethasone is a cheap, generic steroid (a drug that reduces inflammation) that has been widely available for a long time.  Its effective doses and side effects are well understood, and it has been used for many indications.  These characteristics make it an ideal drug to implement wide use.  Its effects in other diseases make these positive results easily understood and expected.

Once a patient has been put on a ventilator for severe COVID-19 with respiratory failure, their chances for survival are poor.  In other diseases, a 50/50 chance of survival on a ventilator was expected, but with COVID-19, as few as 12% of patients have survived.  This is because lung inflammation leads to a cascade of edema, fluid filling of air spaces, and breakdown of lung membranes.  Once inflammation and breakdown is fully established, survival is poor.

The only other way to get around the problem is with extra-corporeal membrane oxygenation (ECMO), a complex technique that is available only at a few regional medical centers.  Ideally, treatment of COVID-19 should prevent patients from deteriorating to the point where they need to be on a ventilator, but no such treatment has been available.

Putting patients who appear to be at risk of going downhill based on their dropping blood oxygen saturation would reduce the risk of having to use a ventilator.  Early treatment with dexamethasone, along with remdesivir, may prevent this.

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