Since March 2020 over 11,500 patients have been enrolled in the RECOVERY trial from more than 175 public hospitals across the UK. In addition to low-dose dexamethasone, other treatments that are currently being trialled are lopinavir with ritonavir, azithromycin, tocilizumab and convalescent plasma.1,3
In the dexamethasone arm, a total of 2,104 patients were randomised to receive usual care (for the participating hospital) plus a daily dose of dexamethasone 6 mg for 10 days (oral or intravenous). This group was compared with 4,321 patients randomised to usual care alone.1
Primary outcome was all-cause mortality at 28 days after randomisation, and follow-up was completed for 94% of participants.1,3
Dexamethasone was not associated with a survival benefit in patients with mild to moderate COVID-19 infection who were managed without respiratory support including supplemental oxygen or ventilation (RR 1.22, 95% CI 0.86 to 1.75, p=0.14).1
Dexamethasone was associated with a reduction in mortality in patients with more severe COVID-19 disease. It reduced deaths by one-third in ventilated patients (rate ratio [RR] 0.65, 95% CI 0.48 to 0.88, p=0.0003) and by one-fifth in other patients receiving oxygen only (RR 0.80, 95% CI 0.67 to 0.96, p=0.0021), compared to standard care alone.1
The RECOVERY chief investigators pointed to the public health importance of the preliminary data stating that, ‘Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone.’1 Professor Peter Horby, one of the chief investigators, further noted, ‘Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.’1
However, they emphasised there was no evidence of benefit for patients who did not require oxygen and that no participants in the dexamethasone arm of the RECOVERY trial had been studied outside the hospital setting.
Read more about the RECOVERY trial