Breakthrough drugs against COVID-19: True or false?

It is apparent that there is an upset in the race for a safe and effective drug or vaccine in the global battle against the pandemic, COVID-19. A well-known, cheap, simple and easily produced and available drug, dexamethasone, has become the first to make a surprising “major breakthrough’’.

Dexamethasone, a steroid being used since the 1960s to treat some ailments, such as breathing problems, arthritis, hormone and immune system disorders and some types of cancers — has proved to be safe and efficacious in treating COVID-19 patients on ventilators and those on oxygen.

Research scientists in the United Kingdom (UK) have found out, during clinical tests, that dexamethasone, also known as dexamed, can reduce death of very sick COVID-19 patients on ventilators from 40 to 28.

For COVID-19 patients on oxygen, it can reduce death among 100 patients treated with the drug to 25. That means, dexamethasone can save about 33 per cent out of 100 patients on ventilators that received the drug, and about 25 per cent patients on oxygen.

It is patients that are critically ill and are on ventilators or oxygen that can benefit from the drug, according to the research scientists’ findings.

How did it all start? The clinical trials took place in the UK. It was done by a team of research scientists who recruited 15,500 patients in 175 hospitals in that country.

The team was led by Prof Peter Horby and his colleague, Prof Martin Landray, and the study is part of what is called Recovery Randomised Evaluation of COVID-19 Therapy.

Their purpose was to do simple testing of repurposed or experimental drugs to find out whether any of them could reduce the risk of death.

Dexamethasone and hydroxychloroquine were two of the many drugs on trial. Half way in the trial, hydroxychloroquine was stopped because the drug was found to have not been helpful to COVID-19 patients.

Dexamethasone is described by the scientists as a low-cost anti-inflammatory steroid in use since the 1960s.

As an immune suppressing drug, there were fears that it would worsen the conditions of COVID-19 patients instead of helping them. “We had some senior doctors writing to us saying: ‘You really shouldn’t be doing this’, and that dampening down the immune system in patients trying to fight an infection was probably not a wise thing to do,” Prof Landray has said.

“The reality was that nobody knew whether dexamethasone would be helpful or harmful,” he noted. Prof Landray explained that what was missing, until then, was a randomised trial which was big enough to reach firm conclusions.

Some of a large number of patients (the biggest in any clinical trial), were given the drug dexamethasone, and others were not.

According to the scientists, the immune system of the patients reacting to the drug, indeed, appeared to have dampened.

However, in doing so, it gave the lungs of the patients an opportunity to recover.

That is what has made dexamethasone, “a major breakthrough” and has now become the standard drug of care to be given to COVID-19 patients on ventilators and those on oxygen.

The Oxford team announced the result of their trials on June 16, 2020.

The World Health Organisation (WHO) has welcomed the new development. It described the drug as “a lifesaving scientific breakthrough’’.

However, some research scientists and doctors in the United States (US) have not been so much enamoured about the drug, dexamethasone, in treating COVID-19 patients.

The American medical experts preferred to wait until more data on the drug and how it works are published and trial results are peer-reviewed.

In reaction, the Oxford University team has promised to publish the full results of their clinical trials in a few weeks.

According to Prof Horby and Prof Landray, the recovery team that discovered dexamethasone as a COVID-19 treatment drug involve about 20 staff in Oxford University, 3,500 doctors, nurses, research scientists and administrative staff across the UK.

Both have said that without the thousands of patients, no medical progress would have been made.

“I say to everyone involved that they should have a warm feeling about the result we are producing because this is how we have advanced medicine,” Prof Landray has said.

The UK scientists have explained why dexamethasone should be used as the first breakthrough drug in the fight against COVID-19.

They have said that the drug, not only significantly reduced mortality rate among COVID-19 patients, it could also be used immediately worldwide to save lives.

Besides cutting the risk of death for patients on ventilators by a third, dexamethasone reduced the risk of death of patients on oxygen by a fifth, according to the research scientists.

Another reason given by the scientists in defence of dexamethasone as a first-line drug for COVID-19 patients is that it is cheap and readily available.

It is a drug that is familiar to all physicians all over the world. Besides, production of dexamethasone in large quantities for immediate use worldwide is easy.

Above all, its properties and side effects are already well known to doctors worldwide.

Meanwhile, another drug, chloroquine phosphate, has been acclaimed, after clinical trials, as another breakthrough medicine for treating COVID-19 patients with serious pneumonia infections.

The drug has proved, in clinical trials, in China to be efficacious and safe in treatment. Chloroquine phosphate is a well-known anti-malaria drug.

The National Health Commission of the People’s Republic of China has recommended that the drug be “included in the next version of the Guidelines for the Prevention, Diagnostics, and Treatment of Pneumonia caused by COVID-19”.

The world is awaiting the result of clinical safety trials of a promising Oxford University vaccine, ZD1222, being developed by the institution.

At earlier trials, the vaccine has proved to be effective in preventing COVID-19 infections.