Dexamethasone – the inexpensive steroid that quickly emerged as a highly effective Covid therapy thanks to a large drug testing programme pioneered by UK scientists – has so far saved the lives of an estimated million people globally, including 22,000 in the UK, according to NHS England.
Called Recovery, the world’s largest randomised Covid-19 drug trial commenced in March 2020 to evaluate the suitability of a suite of different drugs to help hospitalised Covid patients. The study has since been carried out by thousands of doctors and nurses on tens of thousands of patients in hospitals across Britain.
As Covid-19 emerged in late 2019, Oxford University’s Peter Horby, an infectious disease specialist, had begun working on Covid drug trials in Wuhan. But studies were shelved as fierce lockdown restrictions dried up infections in China. Meanwhile, cases began to pop up in Europe.
Horby joined forces with Oxford colleague Martin Landray, a professor of medicine and epidemiology, to set up Recovery. It took them only nine days from drafting their first protocol to the enrolling of the first patient, a process that typically takes nine months.
Less than 100 days after the programme kicked off, trial investigators produced a staggering result – the first medicine that demonstrably improved Covid-19 survival chances. Dexamethasone, a widely available and affordable generic steroid, was shown to cut the risk of death by a third for Covid patients on ventilators, and by nearly a fifth for those on oxygen therapy.
“It was hard to know how many lives would be saved because we didn’t know what the trajectory of the pandemic was going to be, or how well accepted the results would be,” said Horby.
The results were celebrated – and embraced globally. Although Britain was criticised for its initial sluggish response to the pandemic and its bungled testing programmes, Recovery scientists were generously lauded for their heroic efforts to combat the disease.
“It’s clear that dexamethasone has had a big impact,” noted Horby. “A million is a big number … It’s an estimate that could well be lower than that or higher than that. We don’t know.”
The estimates touted by NHS England will be published on Tuesday, but they are understood to be based on a study published in the journal Nature Communications last month, which calculated that roughly 12,000 lives in the UK would have been saved between July and December 2020. This would translate into about 650,000 lives globally over the same period, the researchers wrote.
However, clinical research in low- and middle-income countries with reduced access to oxygen and/or ventilators is key to getting a more accurate reading of the lives saved by employing dexamethasone, the authors cautioned.
“I think it’s made clear in the paper that there’s a lot of assumptions, and more work is really needed to be clear about how the benefits translate in different settings,” said Horby.
Dr Layla McCay, director of policy at the NHS Confederation, which represents hospitals in England, said: “As the science progresses at pace, this is a good lesson for how we can turn cutting-edge research into prompt action to best respond to the next phase of the pandemic, including supporting people who experience long-term symptoms from the disease.”