Recent studies provide more information on what treatments do or do not work for COVID-19, with high-quality methods that provide reliable results.
British researchers published their research on Friday on the only drug that has been shown to improve survival: a cheap steroid called dexamethasone. Two other studies found that the antimalarial drug hydroxychloroquine does not help people with mild symptoms.
For months before studies like these, learning what helps or hurts has been undermined by the “science of despair” as doctors and patients tried therapies on their own or through a series of studies that were not what strong enough to give clear answers.
“For the field to advance and for patient outcomes to improve, there will need to be fewer small or inconclusive studies,” and more like the British, Drs. Anthony Fauci and H. Clifford Lane of the National Institutes of Health wrote in the New England Journal of Medicine.
Now is the time to do more studies comparing treatments and test combinations, said Dr. Peter Bach, a health policy expert at Memorial Sloan Kettering Cancer Center in New York.
Here are the highlights of recent treatment developments:
DEXAMETHASONE
The British study, led by the University of Oxford, tested a type of steroid widely used to reduce inflammation, which can become serious and fatal in the later stages of COVID-19.
Approximately 2,104 patients receiving the drug were compared with 4,321 patients receiving usual care.
It reduced deaths by 36% for patients sick enough to need respiratory machines: 29% with the drug died compared to 41% who received usual care. It reduced the risk of death by 18% for patients who only needed supplemental oxygen: 23% with the drug died compared to 26% of the others.
However, it seemed harmful in earlier stages or in milder cases of illness: 18% of those taking the drug died compared to 14% of those receiving usual care.
The clarity of who benefits and who does not benefit “will likely result in many lives saved,” Fauci and Lane wrote.
Hydroxychloroquine
The same Oxford study also tested hydroxychloroquine rigorously, and the researchers previously said that it did not help hospitalized patients with COVID-19.
After 28 days, approximately 25.7% with hydroxychloroquine had died versus 23.5% with usual care, a difference so small that it could have happened by chance.
Now, details published on a research site for scientists show that the drug may have done harm. Patients who received hydroxychloroquine were less likely to leave the hospital alive within 28 days: 60% with the drug versus 63% with usual care. Those who did not need breathing machines when they started treatment were also more likely to end one or die.
Two other experiments found that early treatment with the drug did not help outpatients with mild COVID-19.
A study of 293 people from Spain published in the journal Clinical Infectious Diseases found no significant difference in the reduction in the amount of virus that patients had, the risk of worsening and the need for hospitalization, or the time to recovery.
A similar study by doctors at the University of Minnesota in Annals of Internal Medicine of 423 mildly ill COVID-19 patients found that hydroxychloroquine did not substantially reduce the severity of symptoms and caused more side effects.
“It’s time to move on” of treating patients with this drug, wrote Dr. Neil Schluger of the New York School of Medicine in a comment in the journal.
REMDESIVIR
The only other therapy that has been shown to help COVID-19 patients is remdesivir, an antiviral that shortens hospitalization by approximately four days on average.
“The role of remdesivir in severe COVID is now what we have to solve,” Bach from Memorial Sloan Kettering wrote in an email, saying the drug needs to be tested in combination with dexamethasone now.
Details of the government-led study of remdesivir have yet to be released, but researchers are eager to see how many patients received other medications, such as steroids and hydroxychloroquine.
Meanwhile, Gilead Sciences, the company that makes remdesivir, which is now administered intravenously, began testing an inhaled version that would allow it to be tested in less sick COVID-19 patients to prevent them from getting sick enough to require hospitalization. . Gilead also began testing remdesivir on a small group of children.
Supplies are very limited, and the United States government is assigning doses to hospitals through September.
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