Celebrate Oxford’s drug on Covid-19 for now!

As Covid-19 cases and hospitalisations continue to rise in the US and other parts of the world, Oxford University scientists provided a much-needed piece of good news: A large, randomised trial in the UK that compared dexamethasone — a generic steroid — to standard treatment found that the drug cut the risk of death in severely ill patients.
The result comes with caveats. Researchers have only disclosed a limited press release’s worth of data at this point and should make haste to publish more details. Until then, some caution is warranted. But the fact that dexamethasone appears to show promise is encouraging and its sheer affordability could help it save lives. In fact, it’s already gained approval for use in treating Covid-19 by Britain’s National Health Service. With the virus still raging and no assurance of a safe and effective vaccine arriving any time soon, effective treatments are going to be essential in managing the pandemic.
The study found that dexamethasone cut deaths by one-third in patients on ventilators and by one-fifth in patients who only needed oxygen. Putting that number in context is essential. According to the researchers, that equates to one life saved for every eight ventilated patients treated, or for every 25 non-ventilated patients who require oxygen. The drug didn’t help patients who didn’t need oxygen. That result makes sense; the medicine is an anti-inflammatory intended to rein in a potentially deadly overactive immune response to infection, an issue that’s likely most pronounced in the sickest patients.
Still, preventing death is an impressive outcome. Gilead Sciences Inc’s remdesivir, already approved for emergency use in several countries, has only proven it can reduce time to recovery. The dexamethasone results also come from a comparison of more than 2,000 patients to a control arm of over 4,000 patients. Once researchers disclose more data, that should serve as the backbone of a data set more robust than the one used to justify remdesivir’s approval.
Unlike remdesivir, dexamethasone is widely available and uncomplicated to manufacture. In comparison to other potentially useful anti-inflammatory drugs such as Roche Holding AG’s Actemra, it’s cheap. These same features formed part of the appeal of hydroxychloroquine, a commonly available malaria drug once hyped as a treatment. Unlike that medicine, which was pulled from the market in the US in part due to results from another arm of the same UK trial, dexamethasone seems like it works.
One saved life for every eight to twenty-five people treated may not seem like much. But there are thousands of people hospitalised around the world right now that could benefit from this medicine, and thousands more are likely to join them if current trends continue. This drug has a better chance than most to reach patients worldwide and could lead to many better outcomes in the months to come.
Dexamethasone isn’t going to stop the pandemic in its tracks, and it shouldn’t substantially shift individual behaviour or opinions about the severe risks involved in contracting Covid-19 or spreading it to others. It certainly shouldn’t underpin an investment thesis for travel stocks. That said, the trial is a step towards understanding the disease; if a decades-old steroid can prevent deaths, there are likely more benefits to reap from other anti-inflammatory drugs or combination therapies.
Silver bullets rarely exist in the world of medicine. But small steps can have a large impact over time.

—Bloomberg