Oxford coronavirus steroid research ‘remarkable’ amid scientific uncertainty, experts say

Top editors from a respected medical journal voiced appreciation for recent research on steroid treatment for coronavirus, regardless of lingering questions and limitations.

The New England Journal of Medicine published the audio interview on Thursday, in which editors said the RECOVERY Trial by researchers at the University of Oxford was “quite remarkable” in a time of scientific uncertainty over the virus.

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The researchers found dexamethasone reduced deaths in patients receiving oxygen by one-fifth and those on ventilators by one-third. The trial enrolled 11,320 patients in England, Scotland, Wales and Northern Ireland. Some 2,104 patients were randomly assigned to get the drug, while another 4,321 patients received usual care.

The NEJM editors said it was “very impressive” how investigators were able to put together a large, randomized controlled trial so quickly, especially because the “biology of this infection wasn’t well understood… and the epidemiology was still being learned.”

They said the multi-arm trial tested different interventions at once, allowed for easy data collection and has influenced practice rapidly, saying “it already is an important component of many treatment guidelines.”

The editors said the drug is already an important component of many treatment guidelines. (iStock)

“Fundamentally, outcomes like mortality are very credible even when collected in such a rapid… diverse way across many medical centers that are not professional clinical study sites so it’s quite remarkable,” said Dr. Lindsey Baden, deputy editor at NEJM.

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The journal’s editor-in-chief, Eric Rubin, said amid the trial, there were changes in the thinking about treatment and therefore unanticipated changes in protocols. He also noted a lot of public interest given the important topic and interest from regulatory authorities who mandated several looks at the data that were unplanned and that influenced the analysis of the results.

“It’s very impressive nevertheless that investigators were able to put together a large, randomized controlled trial so quickly,” Rubin said.

In the trial, researchers found that patients with more severe COVID-19 illness had a greater benefit as opposed to patients with a more mild course.

Dexamethasone was found to reduce deaths in patients receiving oxygen by one-fifth and those on ventilators by one-third. (iStock)

Dexamethasone was found to reduce deaths in patients receiving oxygen by one-fifth and those on ventilators by one-third. (iStock)

“It’s very reassuring to have something to do for these (severely ill) patients because they’re the patients with the poorest outcomes,” Rubin said.

The editors discussed therapeutic approaches and said dexamethasone is an “attractive” option because it’s cheap and globally accessible.

Likewise, in an earlier interview with Fox News, Dr. Panagis Galiatsatos, associate professor and pulmonary and critical care medicine physician at Johns Hopkins Medicine, discussed benefits of dexamethasone compared with other therapies.

“The steroids are cheap and can be given right in the ICU room and have so much better outcomes,” Galiatsatos said.

Rubin noted all the studies seen during the outbreak that were performed rapidly have imperfections, but was impressed nonetheless.

“But as someone who does clinical research, it is incredibly difficult to do,” Baden said. “And to be able to do it rapidly under these circumstances, like you, I am very grateful to have some data to guide my practice than no data. Albeit the data have so many questions around them but that’s the nature of science and it’s the nature of a new disease. It’s the nature of caring for patients in complex circumstances.”

To listen to the full audio interview from NEJM, click here.

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