Experts in Boston’s medical and academic community on Tuesday cautiously welcomed the announcement by researchers in England that a cheap, widely available steroid called dexamethasone can help people survive the deadly coronavirus.
The drug reduced COVID-19 deaths by up to one-third in severely ill hospitalized patients, the researchers said, promising to publish their findings soon.
“Dexamethasone is cheap and available in nearly every corner of the world,” Dr. Ashish Jha, director of the Harvard Global Health Institute, said in a tweet. “Still a challenge to ensure right patients get it.”
He said if the findings hold up, it could “make a real difference” and be a “big win for global health.”
Jha said the trial had shown “reasonably large effects of giving people steroids.”
“Other clinical trials are also ongoing. We need to see the full results. But if this holds up — this is very good news indeed!” he said.
Dr. Nahid Bhadelia, an associate professor at the Boston University School of Medicine who specializes in infectious diseases, said in a tweet that the findings made sense because COVID-19, the disease caused by the coronavirus, wreaks havoc both as a result of direct damage from the virus and from “out-of-control immune activation & inflammation. In severe disease, inflammation & clotting seem to lead to lung injury. Steroids suppress immune system.”
“Mechanistically, this makes sense,” she said.
She said previous studies had raised questions about the benefits of steroid use and led to recommendations against using them, but “I would be willing to believe the current data as this is a study with better methodology and control arm and because other cohorts have shown benefits in severe cases.”
If the study holds up, she said, “Overall, I think this is good news. Steroids are CHEAP. And with more data made available, ICU docs are likely to employ in mechanically ventilated patients who are not improving.”
She said doctors will want to pore over the study’s data to determine whether to change their guidelines, and she called for the data to be released as soon as possible.
Eric Feigl-Ding, an epidemiologist who is a visiting scientist at the Harvard T.H. Chan School of Public Health, tweeted, “Dexamethasone is cheap, available from any pharmacy, and easily obtainable anywhere in the world. This is EXACTLY what we need, instead of a $1000 drug like remdesivir that is just marginally effective for shortening illness but not yet fully proven for mortality.”
Remdesivir, an experimental drug made by Gilead Sciences Inc., received FDA approval last month for emergency use.
Atul Gawande, the prominent Boston-based surgeon, writer, and researcher, struck a cautious note, tweeting, “It will be great news if dexamethasone, a cheap steroid, really does cut deaths by 1/3 in ventilated patients with COVID19, but after all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper.”
By lowering the stakes of being infected, any effective treatment for COVID-19 could be a game-changer for a world that has taken drastic steps to limit the spread of the deadly pandemic — and that wants to return to some kind of normal.
The new study is a large, strict test that randomly assigned 2,104 patients to get the drug and compared them with 4,321 patients getting only usual care.
The drug was given either orally or through an IV. After 28 days, it had reduced deaths by 35% in patients who needed treatment with breathing machines and by 20% in those only needing supplemental oxygen. It did not appear to help less ill patients.
“This is an extremely welcome result,” one study leader, Peter Horby of 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, 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.”
Material from The Associated Press was used in this report.
Martin Finucane can be reached at firstname.lastname@example.org.