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Dr Leon Peto, Dr Mark Campbell and Dr Guilherme Pessoa-Amorim © Adam Gasson/UKRI
L to R Dr Mark Campbell, Dr Leon Peto and Dr Guilherme Pessoa-Amorim

Two years ago today, the RECOVERY trial gave the world its first breakthrough against coronavirus: the discovery that an inexpensive steroid pill, dexamethasone, reduced deaths by up to a third from COVID-19. Within hours, the result was breaking news across the world and hospitals were adopting the drug into the standard care given to all patients with COVID-19. In the nine months following the discovery, dexamethasone saved an estimated one million lives worldwide.

To celebrate this anniversary, RECOVERY has collaborated with news portal The Conversation to produce a special in-depth feature that goes behind the scenes of the study, told in the words of three members of RECOVERY’s research team who helped make it happen. Dr Leon Peto, Dr Mark Campbell, and Dr Guilherme Pessoa-Amorim describe the roller-coaster ride of their RECOVERY trial experience, from desperate hospital wards to moments of jubilation – and even a baby born at home in the midst of a pandemic.

The trio recall the frightening, early days when much of the world was in lockdown and hospitals were flooded with patients they had no idea how to treat. But RECOVERY gave doctors and nurses on the frontline a way they could fight back:

Leon Peto said: ‘I was working on the Infectious Diseases ward at Oxford’s John Radcliffe Hospital in March 2020 when I first heard about the RECOVERY trial. In over a decade working in hospital medicine, I had never known a trial that felt accessible to normal clinicians, but RECOVERY was different. Involvement of medical teams was encouraged and made easy. Already, various drugs had been proposed as treatments for COVID-19, but there was no good evidence that any of them actually helped. We knew that by randomising participants, we would discover if any of the drugs being tested actually did anything. In those early days, I remember that many of us thought dexamethasone was the least promising – until June 2020, when we were delighted to be proved wrong.’

Thanks to RECOVERY’s simple design, focus on key outcomes, and use of routinely-collected patient data, it integrated directly into NHS care pathways, imposing minimal additional burdens on a workforce already under pressure. Combined with the study launching in an unprecedentedly rapid nine days, this enabled RECOVERY to recruit at an astonishing rate, with over 10,000 patients joining the study in the first two months alone. Consequently, within 100 days the study had enough data to generate results for three treatments, with dexamethasone among these. In the article, the team describe the emotional impact of contributing to this breakthrough.

Dr Guilherme Pessoa-Amorim said: ‘Evening TV news shows across the world were suddenly opening with the result of our research, and rightly so. Dexamethasone was the first drug to be shown to save the lives of people infected with COVID-19. To a young researcher like me, that day felt like being part of history. It was a gift from the UK to the world.’

Although RECOVERY will probably be remembered for the dexamethasone result, the study achieved a much wider legacy, as the feature explores. This includes three additional proven COVID-19 treatments: the arthritis drug tocilizumab; a monoclonal antibody treatment, now known as Ronapreve; and baricitinib, an anti-inflammatory drug normally used to treat arthritis. But the researchers also discuss how even the negative results from the study have played a crucial role in the response to the pandemic, by proving that some widely used treatments were actually ineffective, and possibly harmful. Going beyond COVID-19, they also envisage that the RECOVERY model could also improve the design of all kinds of clinical research in the future.

Dr Mark Campbell added: ‘My experience of the pandemic and RECOVERY has impassioned me to pursue opportunities to narrow the gap between randomised trials and normal NHS clinical care – and to contribute to high-quality evidence generation for common medical conditions through randomised trials. In my field of infectious diseases, randomised trials of common conditions are barely performed, despite a lack of high-quality evidence in many areas.’

Read the full article on The Conversation.