Common Drug Reduces Coronavirus Deaths, Scientists
Report
Common Drug Reduces Coronavirus Deaths, Scientists Report |
LONDON — In an unexpected glimmer of hope amid an expanding pandemic, scientists at The University of Oxford said on Tuesday that an inexpensive and commonly available drug reduced deaths in patients with severe Covid-19, the illness caused by the coronavirus.
If the finding is borne out, the drug, a steroid called dexamethasone, would be the first treatment was shown to reduce mortality in the sickest patients and may save
hundreds of thousands of lives, eventually even millions, altering the course
of the pandemic.
Three-quarters
of hospitalized Covid-19 patients receive some form of oxygen. The drug appears
to reduce deaths of patients on ventilators by one-third, and deaths of
patients on oxygen by one-fifth.
Had doctors been using dexamethasone to treat the sickest Covid-19 patients in Britain from the beginning of the pandemic, up to 5,000 deaths could have been prevented, the researchers estimated.
Until now, hospitals
worldwide have had nothing to offer these desperate, dying patients, and the prospect of a lifesaving treatment close at hand — in almost every pharmacy —
was met with something like elation by doctors.
“Assuming that when it goes
through peer review, it stands — and these are well-established researchers —
it’s a huge breakthrough, a major breakthrough,” said Dr. Sam Parnia, a
pulmonologist and associate professor of medicine at the Grossman School of
Medicine at New York University. “I cannot emphasize how important this could
be.”
But the report also comes quickly on the heels of
a series of blunders and retractions in the scientific literature, as
scientists rush to publish research about the coronavirus. While hospitals in
the United Kingdom were able to begin treating severely ill Covid-19 patients
with dexamethasone on Tuesday, many experts in the United States demanded to
see the data and the study itself, which have not yet been peer-reviewed or
published.
“It will be great news if dexamethasone, a
cheap steroid really does cut deaths by ⅓ in ventilated patients with COVID19,” Dr. Atul Gawande wrote
on Twitter, “but after all the retractions and walk backs, it is unacceptable
to tout study results by press release without releasing the paper.”
There is no vaccine against the coronavirus and the only treatment known to be effective, an antiviral drug called redeliver, only shortens the time to recovery
“Dexamethasone is the first
drug to be shown to improve survival in Covid-19,” one of the trial’s chief
investigators, Peter Horby, a professor of emerging infectious diseases at The University of Oxford said
in a statement.
“The survival benefit is clear and large in those patients who are sick enough
to require oxygen treatment.”
Dr.
Horby added that dexamethasone should now become the “standard of care in these
patients,” noting that it was inexpensive, was widely available and could be
used immediately
The drug was not studied in
patients outside of the hospital, however, and was not beneficial to patients
who were not on respiratory support.
Steroids reduce
inflammation in the body and dexamethasone appears to tamp down the virus’s
effects on the lungs. Doctors have been trying it in Covid-19 patients
overwhelmed by so-called cytokine storms — uncontrolled immune responses so
powerful they kill some patients.
Many
doctors had feared the drug might actually exacerbate the infection by
preventing the immune system from attacking the virus. Though Dr. Parnia had
treated patients with steroids and seen improvement, “there had not been such a large trial comparing no steroids with steroids.”
Even without published results, Matt Hancock,
Britain’s health secretary, said doctors in the country’s National Health
Service was able to begin using the steroid as the standard treatment for
hospitalized coronavirus patients on Tuesday afternoon. The drug costs less
than $1 per day of treatment on a single patient.
The government started
stockpiling dexamethasone several months ago based on signs that it could help
patients, Mr. Hancock said, and now has 200,000 doses on hand.
In the trial led by Dr. Horby, about 2,100 severely ill Covid-19 patients were given low doses of dexamethasone, orally or intravenously, once a day. Their outcomes were compared with 4,300 patients who had received the usual care.
The trial was stopped
early because the investigators said that the benefit was obvious. But they
said that the drug did not help moderately ill patients who were not receiving
oxygen.
Corticosteroids like
dexamethasone were used during outbreaks of SARS and MERS, which were also
caused by coronaviruses. But those drugs were associated with worse outcomes,
another reason for hesitation. An earlier, much smaller trial of Covid-19
patients with acute respiratory distress in Spain found that dexamethasone
treatment may reduce the number of times patients are on ventilators and may reduce deaths.
“What this is effectively
doing is tamping down inflammatory responses in patients,” Stuart Neil, a
professor of virology at King’s College London said in an interview. “It’s
almost certain this is affecting the body’s response against Dr. Stephen Griffin, an associate professor in virology at The University of Leeds said that it would be important to study the use of
dexamethasone in combination with antiviral treatments like remdesivir.the
virus, rather than inhibiting the virus itself.”
Dexamethasone has been around for more than 50 years and is
widely used to treat diseases like lupus, arthritis, allergies, and cancer.
Though it may cause side effects, it is generally safe.
Yet many
experts urged caution regarding the results of the new study. With scientists
rushing to identify treatments for the virus as the outbreak spread around the world, some high-profile findings have
had to be retracted or walked back in recent months.
On Monday,
the Food and Drug Administration withdrew its emergency use authorization for
hydroxychloroquine and chloroquine, drugs touted by President Trump as
treatments for Covid-19. Earlier this month, the New England Journal of
Medicine and The Lancet retracted major studies because of flawed data.
Dr. Jose
Scher, a rheumatologist at New York University, said the drug may represent a
“major breakthrough,” but noted that the data have yet to be published in full.
“It has to
be published and peer-reviewed, but if it is in fact true, this is a major
breakthrough,” he said. But “all these communications, without the actual data,
should be taken with caution.”
Hospitals
in the United States appeared to be waiting to see the full study before making
changes.
Dr. Hugh Cassieri, director of critical care medicine at Northwell
Health’s North Shore University Hospital said he would wait for the study to
be peer-reviewed before making changes and would scrutinize the data
personally. “I want to know, ‘What was the severity of the patients’ illness?
Were the patients very, very sick?’”
Randomized controlled
trials are supposed to account for the differences between patients. “But
sometimes that’s not the case, and you have patients who are sicker in the
placebo group and they’re more likely to die compared to the treatment group,
so you’re not really comparing apples to apples,” he said.
Doctors also need more
information about the drug’s side effects, he said.
“This the group has credibility,” tweeted Dr. Jeremy Faust, an emergency room physician
at Brigham and Women’s Hospital in Boston. “But what are the neurological
outcomes? Do we just cause prolonged suffering in one in eight patients on
vents? Or did we help many? No clue!”
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