A study conducted at Oxford University in England found that administering an inexpensive corticosteroid drug, dexamethasone, reduced mortality in COVID-19 patients requiring ventilator support by 35%. When given to patients on oxygen but not yet needing ventilator assistance the reduction in mortality was 16%. Known as the RECOVERY Trial, scientists are hailing this as a major breakthrough in the treatment of COVID-19. The RECOVERY Trial compared the outcomes of approximately 2100 patients randomly assigned to receive dexamethasone against approximately 4300 patients who did not receive the drug. The study results should come as no surprise since mortality in COVID-19 is most often the result of ventilator-associated respiratory failure. It is widely understood that COVID-19 triggers an overly aggressive immune response referred to as the “cytokine storm.” The release of cytokines and interleukins attract phagocytic cells that damage alveolar membranes and lead to acute respiratory distress syndrome (ARDS). Ventilator support is often the only treatment for the condition because positive pressure is needed to force oxygen into inadequately functioning lungs. Depending on the patient’s age and other existing medical conditions, mortality rates for ventilator patients can be more than 50%. The longer a patient remains on a ventilator the less likely he/she can be “weaned off” the ventilator at some future date. Mortality rates have been greater in men than women with no clear explanation for the difference. Prolonged ventilator support weakens chest wall muscles mandating a progressive retraining period before being able to breathe on their own. Dexamethasone is the first drug in a large study to actually demonstrate a clear cut reduction in COVID-19 patient mortality. Unlike remdesivir, the only other drug proven to shorten hospital stays and decrease mortality, dexamethasone is generic and inexpensive. It is also available in a variety of formulations for ease of administration. The results of the RECOVERY Trial have yet to undergo a peer-review analysis and be published. Preliminary results are sufficiently beneficial that dexamethasone should soon become the standard of care in patients requiring ventilator assistance. It should also be strongly considered for use in anyone needing oxygen to correct hypoxemia.
Based on the RECOVERY Trial the Health Ministry in England is recommending the implementation of dexamethasone in the treatment of COVID-19. They have stockpiled some 200,000 treatment courses for use in the national health care system. Research to date indicates that corticosteroids are efficacious in some patients but should be administered on a case by case clinical basis. The RECOVERY Trial produced clear cut benefit in ventilator and oxygen-dependent patients. Those less critically ill patients given corticosteroids may risk more harm than good. Suppressing the immune system when not necessary could lead to pneumonia and sepsis, not to mention the potential for electrolyte disturbances.