British researchers have published their research on the only drug shown to improve survival — a cheap steroid called dexamethasone. Two other studies found that the malaria drug hydroxychloroquine does not help people with only mild symptoms. For months before studies like these, learning what helps or harms has been undermined by “desperation science” as doctors and patients tried therapies on their own or through a host of studies not strong enough to give clear answers.
“For the field to move forward and for patients’ outcomes to improve, there will need to be fewer small or inconclusive studies” and more like the British one, Drs. Anthony Fauci and H. Clifford Lane of the National Institutes of Health wrote in the New England Journal of Medicine.
It’s now time to do more studies comparing treatments and testing combinations, said Dr. Peter Bach, a health policy expert at Memorial Sloan Kettering Cancer Center in New York.
Here are highlights of recent treatment developments: Dexamethasone
The British study, led by the University of Oxford, tested a type of steroid widely used to tamp down inflammation, which can become severe and prove fatal in later stages of COVID-19.
- A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval.
- The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization.
- In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55).
In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.
The same Oxford study also tested hydroxychloroquine in a rigorous manner and researchers previously said it did not help hospitalized patients with COVID-19. After 28 days, about 25.7% on hydroxychloroquine had died versus 23.5% given usual care — a difference so small it could have occurred by chance Now, details published on a research site for scientists show that the drug may have done harm. Patients given hydroxychloroquine were less likely to leave the hospital alive within 28 days — 60% on the drug versus 63% given usual care. Those not needing breathing machines when they started treatment also were more likely to end up on one or to die.