Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe
respiratory complications of COVID-19
In March 2020, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial was established as a
randomised clinical trial to test a range of potential treatments for COVID-19, including low-dose
dexamethasone (a steroid treatment). Over 11,500 patients have been enrolled from over 175 NHS hospitals in
On 8 June, recruitment to the dexamethasone arm was halted since, in the view of the trial Steering Committee,
sufficient patients had been enrolled to establish whether or not the drug had a meaningful benefit.
A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by
intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone.
Among the patients who received usual care alone, 28-day mortality was highest in those who required
ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who
did not require any respiratory intervention (13%).
Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48
to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021).
There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14).
Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25
patients requiring oxygen alone.
Given the public health importance of these results, we are now working to publish the full details as soon as
Peter Horby, Professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of
Oxford, and one of the Chief Investigators for the trial, said: ‘Dexamethasone is the first drug to be shown to
improve survival in COVID-19. This is an extremely welcome result. 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.’
Martin Landray, Professor of Medicine and Epidemiology at the Nuffield Department of Population Health,
University of Oxford, one of the Chief Investigators, said: ‘Since the appearance of COVID-19 six months ago,
the search has been on for treatments that can improve survival, particularly in the sickest patients. These
preliminary results from the RECOVERY trial are very clear – dexamethasone reduces the risk of death among
patients with severe respiratory complications. COVID-19 is a global disease – it is fantastic that the first
treatment demonstrated to reduce mortality is one that is instantly available and affordable worldwide.’
The UK Government’s Chief Scientific Adviser, Sir Patrick Vallance, said: ‘This is tremendous news today from
the Recovery trial showing that dexamethasone is the first drug to reduce mortality from COVID-19. It is
particularly exciting as this is an inexpensive widely available medicine.
‘This is a ground-breaking development in our fight against the disease, and the speed at which researchers
have progressed finding an effective treatment is truly remarkable. It shows the importance of doing high quality
clinical trials and basing decisions on the results of those trials.’
Source: University of Oxford