• 23 Jun 2020
  • 6 min 20
  • 23 Jun 2020
  • 6 min 20

Early results from the RECOVERY trial in the UK are showing that steroid medicine dexamethasone reduces death in hospitalised patients with severe respiratory complications of COVID-19.

In this episode, NPS MedicineWise medical adviser and GP Dr Anna Samecki talks to NPS MedicineWise senior clinical program officer and pharmacist Rawa Osman to take an initial look at what the preliminary results may show, implications for practice in Australia, and some tips on how to have conversations with patients about these findings.


Further reading

NPS MedicineWise article for health professionals - Report suggests dexamethasone reduces mortality in patients seriously ill with COVID-19: https://www.nps.org.au/dexamethasone

WHO - media release, 16/6/20: https://www.who.int/news-room/detail/16-06-2020-who-welcomes-preliminary-results-about-dexamethasone-use-in-treating-critically-ill-covid-19-patients

University of Oxford - media release, 16/6/20: http://www.ox.ac.uk/news/2020-06-16-dexamethasone-reduces-death-hospitalised-patients-severe-respiratory-complications

Transcript

Voiceover:

Welcome to the NPS MedicineWise podcast, helping health professionals stay up to date with the latest news and evidence about medicines and medical tests.

Anna Samecki:

Hi everyone, and welcome to another episode of our NPS MedicineWise podcast, which in recent weeks has focused on COVID-19 issues. Now some of you may already recognize my voice, but for those that don't, I'm Anna, I'm a general practitioner and NPS MedicineWise medical advisor, and I've been sharing the hosting chair, so to speak with our CEO, Steve Morris. Today I'm joined by my colleague Rawa Osman to discuss new developments around a new kid on the block called dexamethasone. So hi Rawa.

Rawa Osman:

Hi Anna. Thank you for having me.

Anna Samecki:

Thanks so much for joining us. Before we begin. Would you mind telling our listeners a little bit more about yourself and what you do?

Rawa Osman:

Yes. So my name is Rawa. I'm a pharmacist by background and I'm a clinical lead at NPS MedicineWise.

Anna Samecki:

Awesome. Thanks for that Rawa. So back to the dexamethasone, there's been some interesting, preliminary results that have been released from a trial called the recovery trial. Rawa, what do you make of this trial? And what's your take on what's transpired?

Rawa Osman:

The recovery trial is a randomised clinical trial that's established during this pandemic just to test the range of potential treatments for COVID-19, including the low dose dexamethasone. So it has over 11,000 patients that have been enrolled from more than 175 public hospitals across the UK. The primary outcomes for this was all cause mortality at 28 days after randomization and the follow up was done for about 94% of the participants.

Anna Samecki:

That's pretty impressive actually. Don't you think?

Rawa Osman:

Oh, absolutely. It's a really big trial. The initial results have been really promising as well. It's showing an association or a reduction in mortality in patients with more severe COVID-19 disease. So the reduction in death was by one third in ventilated patients. That was a statistically significant reduction. And by one fifth of patients who are requiring oxygen, that again was a statistically significant reduction. This was all compared to standard care alone.

Anna Samecki:

And I think you've hit the nail on the head, though there Rawa in regards to the actual patient cohort who saw most benefit. So I think for our listeners, it's important to point out that the patients that had most benefit with those with severe COVID-19. So those that were either ventilated or receive supplemental oxygen. And I believe, unfortunately, on the flip side, there was no survival benefit for patients with mild to moderate COVID-19 and that was those patients did not require oxygen or ventilation. Is that correct, Rawa?

Rawa Osman:

That's correct. And that's why we would need to be really careful when we see the full results that this is not extrapolated beyond the patient cohort, where the benefit was shown. I think with the hydroxychloroquine sort of results that were released early on, we've seen quite a number of patients and prescribers who work in to see if that treatment will work for patients with COVID, whether it's mild, moderate, or severe disease, we would need to view the results, the full results of the trial with the lens of the cohort of patients, where the results was significant.

Anna Samecki:

Yeah, Exactly. I think it's got quite, could potentially have implications for community care and management because certainly there might be a propensity to suddenly go and prescribe or even use it as a preventative prophylactic type medication, which is not what this study was doing. So we do need to be a little bit careful in that. And so Rawa what do you suggest general practitioners and health professionals in the community discuss with the patients? I can only imagine that once this hits mainstream media, there'll probably be plenty of patients that are interested in dexamethasone and how that could be used. So what are we, what do we tell them?

Rawa Osman:

I think it's important that clinicians and other health professionals communicate to patients that dexamethasone has not been shown to prevent infection with COVID-19 that the results here are only limited to patients with severe disease who are requiring ventilation. It's not been shown to be effective for patients with mild to moderate disease, and therefore should not be recommended for patients with COVID-19 symptoms or patients suspected of COVID-19 symptoms. I think that's really important to communicate to patients

Anna Samecki:

Not to mention that, dexamethasone is not without its own risk either. I mean, as a pharmacist you'll know that there are plenty of adverse effects and side effects that come along with it. And even with long term use as well, anything ranging from allergic reactions to increase susceptibility, to infections, hypoglycaemia fluid, and electrolyte disturbances and so forth. So with the potential for abuse is the potential for harm as well in the community. So, hence I think that messaging that you've conveyed is really important.

Rawa Osman:

That's correct. And I think you've hit the nail right on his head that there are side effects that the patient would need to be aware of, of the medicine and they will need to be aware of it's use, when is it safe to use and in what conditions as well?

Anna Samecki:

Yeah, it will be interesting to see the final, I guess, the final paper and, and what that shows once it's published and peer reviewed. So watch this space, everyone, I'm sure we'll have another podcast exploring the finer detail once that's available. So I'd like to just take this opportunity to thank you Rawa for your time. It's been a pleasure and thank you everyone for listening. If you have any questions about or suggestions for any of our podcasts, please reach out to us via Twitter or LinkedIn.

Voiceover:

For more information about the safe and wise use of medicines, visit the NPS MedicineWise website at www.nps.org.au.