47 ms·

Coronavirus: Dexamethasone proves first life-saving drug?

327 points by smartbit 6y ago

barbegal 6y ago
More detailed results on this trial are coming soon but the preliminary results can be found at https://www.recoverytrial.net/results https://www.recoverytrial.net/results
- lbeltrame 6y ago
  This is quite big as a result, although it was done against standard of care (so it can mean a lot of things), because it improves survival. This brings the list of currently effective pharmacological treatments to two: - remedisivir (reduces hospital stay, might improve survival) - dexamethasone (improves survival if requiring oxygen)
  - nerdponx 6y ago
    Now that the "hydroxychloroquine is dangerous" research has been retracted, does HCQ count as a 3rd treatment? Or did we never get confirmation that it was effective? Edit: what's with the downvotes? Go look at my post history, I'm not some Russian astroturfing bot. And I got a lot of informative replies, which is why I asked in the first place.
    - moron4hire 6y ago
      I don't recall seeing anything about it being effective/ineffective as a treatment, only that one study that it doesn't prevent the disease.
    - hprotagonist 6y ago
      we have multiple independent confirmations that it is ineffective against SARS-CoV-2. ( e.g., https://www.recoverytrial.net/files/hcq-recovery-statement-050620-final-002.pdf https://www.recoverytrial.net/files/hcq-recovery-statement-0... , https://www.fda.gov/media/138945/download https://www.fda.gov/media/138945/download) it has known nontrivial side effects, but the study showing measurable harm was retracted.
      - addicted 6y ago
        Also, the study being retracted does not mean it does not cause harm. It just means we don’t have evidence for that at the moment.
        hcknwscommenter 6y ago
        It's not even clear that we don't have evidence. The study was retracted because the authors did not want to provide more details on where/how they obtained their data. Probably because they were contractually obligated not to use the data in the way that they did (they made some vague statements to that effect).
        ray991 6y ago
        You might be interested in this article that tries to explain what happened - from my perspective it was nothing short of a scandal. https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine https://www.theguardian.com/world/2020/jun/03/covid-19-surgi... Others studies by one of the authors (Sapan Desai) whose company Surgisphere is supposed to be behind the alleged fraud are being scrutinised and even his credentials are under question now - https://www.theguardian.com/world/2020/jun/10/surgisphere-sapan-desai-lancet-study-hydroxychloroquine-mass-audit-scientific-papers https://www.theguardian.com/world/2020/jun/10/surgisphere-sa...
        hprotagonist 6y ago
        i’d trust RetractionWatch here, which also has good coverage.
    - mhandley 6y ago
      The same group that conducted this Dexmathasone study concluded that hydroxychloroquine is ineffective: https://www.recoverytrial.net/files/hcq-recovery-statement-050620-final-002.pdf https://www.recoverytrial.net/files/hcq-recovery-statement-0... "These data convincingly rule out any meaningful mortality benefit of hydroxychloroquine in patients hospitalised with COVID-19." Note this is not the same group or dataset as the discredited study.
      - jtbayly 6y ago
        If they were indeed giving deadly doses of the drug by accident, it’s no wonder they stopped the study cold turkey.
        lbeltrame 6y ago
        That statement is not correct because it does not take into account the pharmacokinetics of the drug. See the discussion here[1] (from the person who wrote the open letter to Lancet on the now-retracted HCQ study). [1] https://twitter.com/jwato_watson/status/1272734274823663616 https://twitter.com/jwato_watson/status/1272734274823663616
        jtbayly 6y ago
        That’s a helpful link. Thx. Looks like no fatal doses. But I wasn’t claiming they were doing so. I said “if” intentionally, since I know nothing about it.
      - lbeltrame 6y ago
        To be even more precise, ineffective in hospitalized patients. UMN has done another study for "outpatient" (that is, not hospitalized) treatment and sent the results for review. I'm not expecting any different results than from this one, but we'll know soon enough. The RECOVERY study is also studying azithromycin, a drug commonly administered with HCQ when used against this disease. It would be ironic if that one proves to be effective (study is still ongoing).
    - m4r35n357 6y ago
      It was only ever a con, perpetrated by corrupt politicians.
    - cheaprentalyeti 6y ago
      Are you referring to the retracted Lancet study or the just-breaking-news about the Oxford Recovery Trial where they were using lethal dosages of the drug? [1] [1] http://covexit.com/recovery-covid-19-research-blasted-for-toxic-dosage-towards-oxfordgate/ http://covexit.com/recovery-covid-19-research-blasted-for-to...
      - rsynnott 6y ago
        This seems to be the response to every trial that shows chloroquine and friends to be ineffective, though. "Well, of course there was no positive effect, the dose was too low." "Well, of course there was no positive effect, the dose was too high". "Well, of course there was no positive effect, you didn't tape a halibut to the patient's head". "No, not a cooked one, you fools, a live one!" At a certain point, it's possibly worth considering that there may be no there there.
        jcranmer 6y ago
        I've noticed on Derek Lowe's blog that there seems to be a definite hydroxychloroquine brigade that doesn't exist for any other purported therapy. And as you noticed, this brigade will pick apart HCQ studies for not doing X for a bajillion different varieties of X. (Not simultaneously dosing with zinc and/or azithromycin is the one that tends to be mocked the hardest on the blogs).
        jbritton 6y ago
        Here is a preprint that shows HCQ plus Zinc is effective. My knowledge on this matter comes only from watching a few YouTube videos. From that it has seemed all along that the treatment required is HCQ + Zinc. Zinc is what stops viral replication and HCQ helps get Zinc into the cells. So why are so many trials not using Zinc. https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1 https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v...
        downerending 6y ago
        Before any of the studies came out, I was reading anecdotes specifically stating, "this only works with zinc". Which is not that hard to believe, from a biochemical perspective. Apparently most or all of the studies do not include zinc. Hooray.
    - rsynnott 6y ago
      The same trial found hydroxychloroquine not to be effective, and patients are no longer being enrolled in that arm of the trial: https://www.recoverytrial.net/files/hcq-recovery-statement-050620-final-002.pdf https://www.recoverytrial.net/files/hcq-recovery-statement-0...
    - vibrio 6y ago
      I'd not start dropping HCQ like candy. Beyond the retracted COVID study, it is established that there are risks associated with HCQ usage. use can lead to cardiomyopathy, prolong QT interval and trigger arrhythmia. source: drop chloroquine cardiomyopathy into pubmed or google scholar.
      - nerdponx 6y ago
        There's quite a spectrum between "HCQ is dangerous and ineffective for Covid-19" and "drink fish tank cleaner".
        vibrio 6y ago
        I agree with you that "dangerous" isn't binary. To be clear, the medical literature I was referencing are focused on medical grade HCQ. I apologize that I was glib in my "like candy" comment. I'm reacting strongly to this topic because the current level of pop-culture medical expertise, partiuclary around HCQ and also vaccines, is concerning to me.
    - Symmetry 6y ago
      We've been dosing people with hydroxychloroquine for malaria for years so it would be very surprising if it suddenly turned dangerous. It's pretty clear at this point from a number of randomized trials that giving it to people who have developed Covid-19 isn't particularly useful. It's still possible that it might be useful prophylacticly, there's been some promising non-RCT studies coming out of India and at least one RCT underway, but I'm not sure I'd bet on it. EDIT: And to be clear the Indian studies suggested you wanted to be taking it for weeks before first exposure to SARS-2.
      - wbl 6y ago
        It's always dangerous. It has a black box warning for arrhythmia.
      - Nursie 6y ago
        > it would be very surprising if it suddenly turned dangerous https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/009768s037s045s047lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/00... Just because something is a useful medicine that's been given for a while doesn't mean it can't also have serious side effects, some of which could conceivably exacerbate Sars-CoV-2. Or not, there's no evidence that it does. But a lot of medicines are "dangerous", including Plaquenil, particularly if applied for the wrong circumstance or given to people with contraindications.
    - Nursie 6y ago
      > Or did we never get confirmation that it was effective? The reverse, there's confirmation it's ineffective. It may not be dangerous (I don't know) but it's no longer allowed as treatment in the US as the evidence has shown it's not useful. Can we stop talking about this and move on yet? It was only ever really of interest because Trump was flailing about for anything to make it look like he had a plan earlier in the year.
      - gfodor 6y ago
        No, there was interest because this was used in South Korea. Then, trump said a thing, everyone lost their minds, studies were rushed, the press lied about intermediate statistically-insignificant results, and it was a complete embarrassment to the medical community. The politicization of a medicine has been one of the stupidest things I’ve ever seen in my lifetime.
        Nursie 6y ago
        > The politicization of a medicine has been one of the stupidest things I’ve ever seen in my lifetime. Couldn't agree more. It's insane that medical science gets turned into a partisan pissing match.
        pjc50 6y ago
        > The politicization of a medicine has been one of the stupidest things I’ve ever seen in my lifetime. This seems to have been going on since Wakefield and the anti-vaxers; and one of the big reasons for rejecting chloroquine was exactly that it was being promoted by a whole infrastructure of dodgy quack websites. Which is undoubtedly where Trump got the idea from.
      - WillPostForFood 6y ago
        It may not be dangerous (I don't know) but it's no longer allowed as treatment in the US This is not true. It is still allowed as a treatment, and there are still studies going on using it in the US. The FDA emergency approval has been removed, which is more of a technical status. You can no longer acquire it from the government stockpile, and it is no longer recommended.
    - hannob 6y ago
      We never got confirmation that it was effective. All the early studies that indicated some effectiveness were basically garbage. The french study that caused most hype was flawed in multiple ways. The fact that a study showing its ineffectiveness was retracted is not evidence of the opposite.
    - SomeoneFromCA 6y ago
      Chloroquine (not hydroxy, good old chloro) is used in Central Asia. Death rate is pretty low (less than 10 per million), if you trust official media source of the countries in the region.
    - marcosdumay 6y ago
      There was more than one study that found HCQ dangerous. None had a clear effect. AFAIK, at this point we can't tell if it has a very tiny positive effect or a small damaging one. None are good news, so why push it further?
  - zaroth 6y ago
    > For patients on ventilators, it cut the risk of death from 40% to 28%. For patients needing oxygen, it cut the risk of death from 25% to 20%. But I would guess that the survival rate for patients who don't require oxygen must be pretty damn high to start with.
    - barbegal 6y ago
      From the released statement: > Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).
      - zaroth 6y ago
        I wonder what 13% of people are dying from with COVID if it isn’t SARS...
        orwin 6y ago
        Ive heard its heart attack.
        S_A_P 6y ago
        Most likely this. Low blood oxygen stresses the cardiovascular system so there are greater odds that anything that can go wrong there will.
        nradov 6y ago
        Cytokine storm syndrome https://www.sciencedaily.com/releases/2020/05/200513081810.htm https://www.sciencedaily.com/releases/2020/05/200513081810.h...
        knowaveragejoe 6y ago
        This, as well as Disseminated Intravascular Coagulation(DIC). https://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation https://en.wikipedia.org/wiki/Disseminated_intravascular_coa... https://emcrit.org/ibcc/covid19/#disseminated_intravascular_coagulation https://emcrit.org/ibcc/covid19/#disseminated_intravascular_...
  - heisenbit 6y ago
    Two other treatments with results - low dose of blood thinner (also significant improvement and widely available) - IL-6 inhibitor tocilizumab (some improvement in severe cases but expensive and hard to scale up) Both dexamethasone and tocilizumab weaken the immune system. Helps against the overshooting but risks other infections.
    - sp332 6y ago
      Do you have some links to news about these?
      - heisenbit 6y ago
        If you want to follow Reddit r/COVID19 is regularly posting preprints and has quite a number of professionals in the comments.
    - CWuestefeld 6y ago
      I've seen small observational studies with positive results about other IL-6 and TNF-a inhibitors, like Remicade. I have a particular interest in this because of Crohn's Disease - might the disease be making me high risk, and might my treatment (Entyvio, which operates differently from Remicade and its kin) help offset that anyway?
  - JadeNB 6y ago
    > it was done against standard of care (so it can mean a lot of things) This looks like a technical phrase, and the parenthesis suggests that its meaning or implications should maybe be obvious, but they aren't to me! Do you mind elaborating?
    - lbeltrame 6y ago
      "Standard of care" basically means "whatever the current protocol to treat the disease is" (normally it means "the accepted treatment", but there isn't one yet), which can mean just trying to keep the fever down, supplementation of fluids, but also administration of drugs (with the exception of the one tested, of course). As you can imagine, it is quite variable in what it means, because it varies across countries and occasionally even hospitals (I'm sure the RECOVERY people have taken this into account, though). It is different from a placebo study because in that case your control is something you know is inert and "does nothing".
      - JadeNB 6y ago
        Thank you!
amelius 6y ago
> A cheap and widely available drug called dexamethasone can help save the lives of patients who are seriously ill with coronavirus. Yes, cheap until it gets patented because that is what usually happens when a drug is repurposed.
- m4r35n357 6y ago
  Just let them try! ;)
- Mvandenbergh 6y ago
  Using dexamethasone (an anti-inflammatory drug) to reduce inflammation is not patentable.
- ringwalt 6y ago
  Glucocorticoids are very old drugs. If there were a new patent at this stage in the US, it would be a combination drug or delayed release oral form ([source](https://www.patentdocs.org/2018/09/patenting-repurposed-drugs.html) https://www.patentdocs.org/2018/09/patenting-repurposed-drug...). There's also a dozen alternative generic analogues. There's already a [markup](https://www.washingtonpost.com/news/wonk/wp/2018/06/19/the-growing-case-against-iv-tylenol-once-seen-as-a-solution-to-the-opioid-crisis/ https://www.washingtonpost.com/news/wonk/wp/2018/06/19/the-g...) for very common drugs in IV form, which is bad, but unfortunately it's a very small part of the ICU bill to begin with in the US.
- aroch 6y ago
  Given that it was discovered in the 1950's, I don't think you're going to see a patent on the versions currently being used in clinic. Now,if someone creates a more bio-available/active functionalized variant of it, fine that might get patented. But I doubt it would have much of an impact on the suggested COVID19 treatment (and would likely be years away from market)
  - kgwgk 6y ago
    You can actually get patent protection on things like dosage and indications. But it's much weaker than for composition-of-matter patents and often courts rule in favor of challengers.
danans 6y ago
This is good news, but it doesn't change anything from a public health perspective, because: > Of those who are admitted, most also recover but some may need oxygen or mechanical ventilation. > And these are the high-risk patients dexamethasone appears to help. At best this might take a little bit of pressure off the healthcare system in the treatment of the most severe cases. As others pointed, steroids are powerful/dangerous stuff so they won't be using this except in the most advanced cases.
- jpxw 6y ago
  I’m not sure if the low-dose dexamethasone treatment really is that “dangerous”, frankly. Steroids do have side-effects, but this drug is quite well-known and used frequently. Under medical supervision, and especially if the dosage is low, it seems likely it will be safe.
- rsynnott 6y ago
  I mean, most people who are dying receive oxygen and/or ventilation. If it does significantly reduce death rate there, that's not nothing.
  - danans 6y ago
    Definitely not nothing. My point is that this treatment, however effective, isn't effective early enough in the disease's progression such that it allows us to reduce public health response measures by any significant amount, whereas a treatment that was very effective at an earlier stage of the disease would.
    - rsynnott 6y ago
      Oh, yeah, definitely. Such a treatment would be a game changer, and this one is not. Still, in the absence of such a treatment, this is very nice to have.
deleted 6y ago
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nodesocket 6y ago
I’m a little frustrated that all the doctors seemed to have gotten this wrong. Using steroids was completely missed and ignored as a treatment for severe patients, as I understand dexamethasone was only shown to help people on oxygen or ventilators. It seems everybody was focused on covid being a respiratory disease, when in fact it looks like it’s actually circulatory.
- rscho 6y ago
  It was not missed. The recommendations during the first wave were to avoid corticosteroids because they were thought to be nefarious in this case. At least in Europe. Now we switched to the opposite. Behold, medical statistics the 8th world's marvel!
- EGreg 6y ago
  What do you mean it was missed? Corticosteroids were recommended to reduce the body’s overreaction. What I am wondering about is whatever happened to Ivermectin, that was so promising back in April. MERCK makes Stromectol since the 70s. Clears the entire infection in 48 hours! https://www.medicalnewstoday.com/articles/could-an-antiparasitic-drug-kill-off-sars-cov-2-within-2-days https://www.medicalnewstoday.com/articles/could-an-antiparas...
  - rscho 6y ago
    European experts actively recommended not to give corticosteroids at the start of the pandemic and changed course late in the first wave. We had direct communication with those experts in my hospital and local guidelines didn't recommend steroids.
    - jfoster 6y ago
      Would be interesting to know what they based that on.
  - sp332 6y ago
    *In cell cultures. It's in at least one trial. https://clinicaltrials.gov/ct2/show/NCT04374279 https://clinicaltrials.gov/ct2/show/NCT04374279 Estimated completion date is this month, so keep an eye out.
jcahill 6y ago
This is the RECOVERY trial. They have already likely killed patients through gross incompetence (see below). If you aren't asking the strongest lifesci researchers you know to read the fine print on every word coming from RECOVERY, you should draw no conclusions. How dare Landray even speak to the press at this point? From 2020-06-15: A large UK COVID-19 trial, the RECOVERY trial⁽¹⁾, likely killed patients with a 2400mg dose of hydroxychloroquine⁽²⁾ after one of its main authors confused hydroxychloroquine with hydroxyquinoline. This author was quoted in an interview by FranceSoir⁽³⁾⁽⁴⁾ on the topic and the project team is now running damage control, trying to claim that he was misunderstood etc. The amoebic dysentery answer in this exchange⁽⁵⁾ indicates the confusion with hydroxyquinoline and the "six to ten times" answer removes plausible deniability with respect to the administration of lethal dosages. ¹ https://recoverytrial.net https://recoverytrial.net ² https://threadreaderapp.com/thread/1272209860512419840.html https://threadreaderapp.com/thread/1272209860512419840.html ³ http://covexit.com/recovery-covid-19-research-blasted-for-toxic-dosage-towards-oxfordgate http://covexit.com/recovery-covid-19-research-blasted-for-to... ⁴ http://www.francesoir.fr/politique-monde/interview-exclusive-martin-landray-recovery-hydroxychloroquine-game-over-uk http://www.francesoir.fr/politique-monde/interview-exclusive... ⁵ https://files.catbox.moe/s9qc7v.png https://files.catbox.moe/s9qc7v.png
- jcahill 6y ago
  Here is the relevant file to comb over for today's dexamethasone result: ⁶ https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf https://www.recoverytrial.net/files/recovery_dexamethasone_s... Relevant passage: > A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%). Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14). Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone. Given the public health importance of these results, we are now working to publish the full details as soon as possible.
Tenoke 6y ago
As far as I can tell it is extremely common to give steroids (and dexamethasone is among the default choices) in those cases already. I can't quite tell but it doesn't sounds like it was compared to other steroids so I would hold judgement before we hear more. At any rate, hype over initial briefly reported findings is rarely useful. Edit: I was checking how common was it to give corticosteroids before the trial (pretty common as I suspected) but it's almost amusing that the WHO was recommending not to use it[0]. I wonder if this will be yet another miss for them. 0. https://www.contagionlive.com/news/is-there-any-reason-to-use-corticosteroids-in-coronavirus-treatment https://www.contagionlive.com/news/is-there-any-reason-to-us...
- newacct583 6y ago
  > it's almost amusing that the WHO was recommending not to use it Why is everyone picking on the WHO constantly? It's like it's a reflex at this point, as far as I can tell designed to shift "blame" off of... other parties who got lots of stuff wrong. In this case you're spinning really hard. The WHO guidance you're quoting, quoted in the article you link, was really mild: "“Given lack of effectiveness and possible harm, routine corticosteroids should be avoided unless they are indicated for another reason,” WHO authors wrote." Is that really unreasonable? In January they didn't have evidence of effectiveness, and drugs have side effects. Sounds like correct reasoning to me. Do you actually disagree? And in any case that quote is from a document in January, the current version (from March, also linked from the article) is here, and makes a bunch of complicated points about steroid use, citing contemporary research which was inconsistent about effect: https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf https://www.who.int/docs/default-source/coronaviruse/clinica...
  - Tenoke 6y ago
    >Why is everyone picking on the WHO constantly? Because they've made multiple avoidable bad calls. >In this case you're spinning really hard. 'WHO was recommending not to use it' is a quick summary of statements like "routine corticosteroids should be avoided unless they are indicated for another reason,”. How is this not a recommendation against it and 'spinning really hard'? At any rate, I didn't dig into that part much (WHO recommendations are much much less important than medical trials), I just found it interesting enough to mention.
csomar 6y ago
Dexamethasone is a serious drug and corticosteroid [1]. It was prescribed for a friend after eye-surgery and having skin / eye inflammation problems, I used it (with no doctors advice) recklessly albeit with very small quantities. The drug was hyper-effective. An unbelievably tiny quantity can remove any inflammation (eye, skin, hair skin rash, etc...). But the fall out and side-effects are no joke even for seemingly super minuscule doses. It was a horror story for me with horrible eye inflammation, small inflammations in different parts of the body and a skin rash I still struggle with until today. Mind you I took small localized doses and not an injection. I wasn't aware that it can travel through your skin, get into your blood and make a mess. I think the research will need to specify potential side-effects and their probabilities. It's trade-off at the end of the day. PS: Do not ever think of trying it without medical advice and doctor supervision. [1]: https://en.wikipedia.org/wiki/Dexamethasone#Adverse_effects https://en.wikipedia.org/wiki/Dexamethasone#Adverse_effects
- ceejayoz 6y ago
  To be clear, it's generally advisable to only take a prescription drug under the direction of a doctor. This isn't unique to dexamethasone. Steroids plus eyes can lead to glaucoma. My doc won't let me use them anywhere near the face.
  - cactus2093 6y ago
    Random aside - I wish I had a tough love doctor that would tell it to me like it is, and pay close enough attention to refuse to let me do things. I don’t even really use the term “my doctor”, I just see a doctor when I need to. I’m 30 and live in a large city, and I’ve rarely seen the same doctor more than a couple times in a row. I go in for a physical roughly once a year, and the doctor will sit and talk with me for 10 minutes or so. But otherwise if I need something checked out in between I often get seen by a PA or whatever doctor in the practice is free. I’ve never really felt encouraged by the same doctor to see them repeatedly, or to email them personally if I have a medical question like I know some people do. So when I move to a different neighborhood or something, I just end up seeing a different doctor next time. Am I just getting bad doctors? How do you find this type of buddy doctor that becomes a long term relationship and really cares about you personally, like I hear about other people seeming to have.
deleted 6y ago
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userbinator 6y ago
This doesn't seem all that surprising --- I recall reading that steroids were also the choice of treatment for SARS many years ago.
- acallaghan 6y ago
  That's probably why they tested it?
axegon_ 6y ago
I only knew of Dexamethasone as cancer treatment. Which intuitively makes me wanna question how good of an idea this is. That said, my knowledge on medicine outside the sheer basics is practically none... I mean correct me if I'm wrong here but aren't cancer treatment drugs prone to cause severe side effects in general?
- vajrabum 6y ago
  Dexamethasone is not cancer specific. It is used in cancer treatment but mostly to reduce swelling and the effects of tumors. It doesn't have the side effects of chemo. It has its own set of problems it brings with the benefits.
- _nalply 6y ago
  I know of Dexamethasone as an anti-emetic for chemotherapy. It doesn't treat cancer but treats one side-effect of chemotherapy. It seems to be so helpful such that it enables some forms of chemotherapy not possible before. It seems weird to use a corticosteroid as an anti-emetic but I have seen with my own eyes that it is helpful.
christefano 6y ago
I thought that name was familiar. It’s the miracle drug called “dex” and hyped in the Chris O’Donnell movie, Vertical Limit. My bet is Vertical Limit is the next movie to trend (after Contagion): https://en.m.wikipedia.org/wiki/Vertical_Limit https://en.m.wikipedia.org/wiki/Vertical_Limit
- improbable22 6y ago
  Haven't seen the movie but it is one of the drugs prescribed for altitude sickness. Or rather, one of the ones often carried for use in life-threatening cases.
- dilyevsky 6y ago
  It’s routinely taken for prophylaxis and treatment of hape/hace by high altitude mountaineers (and not just because of the film)
aazaa 6y ago
More informative article here: https://www.statnews.com/2020/06/16/major-study-finds-common-steroid-reduces-deaths-among-patients-with-severe-covid-19/ https://www.statnews.com/2020/06/16/major-study-finds-common... The problem is that there is little more than a press announcement at this point. There are no data. There is no paper. There are no details to consider. We've seen this movie before, and it's gone badly (remdesivir, hydroxychloroquine). Safe and effective drugs require copious details, and you'll find none of them here.
- selimthegrim 6y ago
  What's bad about remdesivir?
  - SmkyMt 6y ago
    "The most common adverse effects in studies of remdesivir for COVID‑19 include respiratory failure and organ impairment..." —wikipedia entry
    - delecti 6y ago
      That sounds more like "sometimes it doesn't work" than "sometimes it extra kills you".
  - WhompingWindows 6y ago
    It's simply not that effective, it has a very small treatment effect and isn't a great tool, but it's certainly much more justifiable than hydroxychloroquine, which took much of the oxygen out of the room when POTUS and the GOP hyped it FAR beyond its statistically shown merits.
    - amluto 6y ago
      Also: it has serious manufacturability issues, and it can only be administered by IV. It’s entirely plausible that giving remdesivir to COVID-19 patients when they first show symptoms would make a big difference, but it’s impractical.
ReticentVole 6y ago
If this cuts deaths by 1/3rd, isn't that totally sufficient to end all lockdowns and border restrictions immediately? The death rate looks basically like the annual flu with this drug, particularly when we consider that it will just be one bad season then fairly minor from then on, when much of the population gets natural immunity.
- mrlala 6y ago
  It's baffling that you are comparing the death rate that happened DURING A LONG LOCKDOWN with a non-lockdown annual flu death rate.. and acting like if we can drop the numbers a bit it's the same thing. Your logic is essentially saying the lockdown did nothing to reduce deaths/infection.
  - jeffreyrogers 6y ago
    They are talking about the death rate, not the absolute number of deaths.
    - rsynnott 6y ago
      I mean, that would still be wrong. IFR for flu is about 0.1% in a normal year. Most reputable estimates for the IFR for COVID are about 1%.
      - ReticentVole 6y ago
        CDC estimated it at 0.26%: https://in.dental-tribune.com/news/new-estimate-by-the-cdc-brings-down-the-covid-19-death-rate-to-just-0-26-as-against-whos-3-4/ https://in.dental-tribune.com/news/new-estimate-by-the-cdc-b...
        rsynnott 6y ago
        That estimate wasn't particularly well-received, and the facts on the ground make it look especially dubious. NYC has has 17k deaths, for instance, mostly in April and early May. If you assume that _everyone_ in NYC has been infected, that would be an IFR of 0.2%. An antibody survey in late April found a prevalence of about 25% in New York City, which, assuming it's accurate (huge assumption, obviously) would indicate a rate of about 0.8%.
mbostleman 6y ago
Dex is an important part of a first aid kit for high altitude mountaineering as it's somewhat unpredictable who will be afflicted by various issues related to altitude or when.
JoeAltmaier 6y ago
This drug may be a hammer, and a better tool is desirable. But finally, a hammer that may work! I am hopeful this will move us faster along the direction of normalizing.
parasubvert 6y ago
I had idiopathic acute pericarditis several years ago with two months of anti inflammatories keeping it in check, but ultimately 3 days of low dose dexamethasone finished the job. My case was thought to be autoimmune - similar to the cytokine storm spoken of with COVID-19. Very effective and potent steroid.
f0ok 6y ago
Where is the study?
teknopaul 6y ago
How does this information "About 19 out of 20 patients with coronavirus recover without being admitted to hospital. Of those who are admitted, most also recover but some may need oxygen or mechanical ventilation." Get said along side a published ~10% death rate. There have 300,000 cases in the UK and 40,000 deaths.
- PureParadigm 6y ago
  It's possible there are more than 300,000 cases, since not everyone with the virus gets tested, so you can't assume 40,000/300,000 is the true death rate. There are likely many with milder symptoms who do not get tested and recover without going to the hospital, so the true death rate is lower than the confirmed deaths/confirmed cases figure.
- jjjensen90 6y ago
  There is no "death rate" metric. There is CFR (case fatality rate) and IFR (infection fatality rate). We know that there are many more infections than known cases, and serological studies point to total IFR <1%, with massive stratifications by age (<50 having extremely few fatalities, and >50 having increasing IFR every age bracket).
- GuB-42 6y ago
  The best estimate, based on New York data, puts the death rate at 1.4% [1] The number of cases in the UK is likely to be underestimated by a factor of 10 because it only takes into account cases confirmed by testing, and not everyone is tested, especially not mild/asymptomatic cases. This is consistent with several other studies in various places. [1] https://www.worldometers.info/coronavirus/coronavirus-death-rate/ https://www.worldometers.info/coronavirus/coronavirus-death-...
hcarvalhoalves 6y ago
Isn't administration of (potent) steroids the standard treatment for autoimmune reactions - what seems to happen on the extreme cases of COVID - already?
- thehappypm 6y ago
  It’s done commonly, but steroids are such a broad field of medicine that it’s almost like saying “don’t doctors already prescribe chemicals?”
dzink 6y ago
The title is click-bait. This and other steroids have been used by doctors against COVID-19 from the beginning. So have blood thinners, and plenty of other medications, and even radiation. From what has been gathered so far, COVID leads to an attack on the endothelial layer of your blood vessels that is responsible for clotting. That causes potentially permanent damage and if immunity doesn't last long, also potentially accumulating cardiovascular, pulmonary, and renal damage. From there COVID or the body's immune response can hit multiple organs at different times turning your life into a flimsy house of cards. Medicines for one organ can kill another (blood thinner targeting a clot in your body can and does cause a stroke, or some other issue). Just like a little push of the gas pedal or the breaks. The driver's (your doctor's) skill is far more important than a single medicine at this point.
- jryle70 6y ago
  NYT seems to think it's a big deal [0] > Assuming that when it goes through peer review it stands — and these are well-established researchers — it’s a huge breakthrough, a major breakthrough,” said Dr. Sam Parnia, a pulmonologist and associate professor of medicine at the Grossman School of Medicine at New York University. [0] - https://www.nytimes.com/2020/06/16/world/coronavirus-live-updates.html?action=click&pgtype=Article&state=default&module=styln-coronavirus&region=TOP_BANNER&context=storylines_menu#link-2c3ace49 https://www.nytimes.com/2020/06/16/world/coronavirus-live-up...
deleted 6y ago
[deleted]

327 points by smartbit 6y ago

More detailed results on this trial are coming soon but the preliminary results can be found at https://www.recoverytrial.net/results https://www.recoverytrial.net/results

lbeltrame 6y ago
This is quite big as a result, although it was done against standard of care (so it can mean a lot of things), because it improves survival. This brings the list of currently effective pharmacological treatments to two: - remedisivir (reduces hospital stay, might improve survival) - dexamethasone (improves survival if requiring oxygen)
- nerdponx 6y ago
  Now that the "hydroxychloroquine is dangerous" research has been retracted, does HCQ count as a 3rd treatment? Or did we never get confirmation that it was effective? Edit: what's with the downvotes? Go look at my post history, I'm not some Russian astroturfing bot. And I got a lot of informative replies, which is why I asked in the first place.
  - moron4hire 6y ago
    I don't recall seeing anything about it being effective/ineffective as a treatment, only that one study that it doesn't prevent the disease.
  - hprotagonist 6y ago
    we have multiple independent confirmations that it is ineffective against SARS-CoV-2. ( e.g., https://www.recoverytrial.net/files/hcq-recovery-statement-050620-final-002.pdf https://www.recoverytrial.net/files/hcq-recovery-statement-0... , https://www.fda.gov/media/138945/download https://www.fda.gov/media/138945/download) it has known nontrivial side effects, but the study showing measurable harm was retracted.
    - addicted 6y ago
      Also, the study being retracted does not mean it does not cause harm. It just means we don’t have evidence for that at the moment.
      - hcknwscommenter 6y ago
        It's not even clear that we don't have evidence. The study was retracted because the authors did not want to provide more details on where/how they obtained their data. Probably because they were contractually obligated not to use the data in the way that they did (they made some vague statements to that effect).
        ray991 6y ago
        You might be interested in this article that tries to explain what happened - from my perspective it was nothing short of a scandal. https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine https://www.theguardian.com/world/2020/jun/03/covid-19-surgi... Others studies by one of the authors (Sapan Desai) whose company Surgisphere is supposed to be behind the alleged fraud are being scrutinised and even his credentials are under question now - https://www.theguardian.com/world/2020/jun/10/surgisphere-sapan-desai-lancet-study-hydroxychloroquine-mass-audit-scientific-papers https://www.theguardian.com/world/2020/jun/10/surgisphere-sa...
        hprotagonist 6y ago
        i’d trust RetractionWatch here, which also has good coverage.
  - mhandley 6y ago
    The same group that conducted this Dexmathasone study concluded that hydroxychloroquine is ineffective: https://www.recoverytrial.net/files/hcq-recovery-statement-050620-final-002.pdf https://www.recoverytrial.net/files/hcq-recovery-statement-0... "These data convincingly rule out any meaningful mortality benefit of hydroxychloroquine in patients hospitalised with COVID-19." Note this is not the same group or dataset as the discredited study.
    - jtbayly 6y ago
      If they were indeed giving deadly doses of the drug by accident, it’s no wonder they stopped the study cold turkey.
      - lbeltrame 6y ago
        That statement is not correct because it does not take into account the pharmacokinetics of the drug. See the discussion here[1] (from the person who wrote the open letter to Lancet on the now-retracted HCQ study). [1] https://twitter.com/jwato_watson/status/1272734274823663616 https://twitter.com/jwato_watson/status/1272734274823663616
        jtbayly 6y ago
        That’s a helpful link. Thx. Looks like no fatal doses. But I wasn’t claiming they were doing so. I said “if” intentionally, since I know nothing about it.
    - lbeltrame 6y ago
      To be even more precise, ineffective in hospitalized patients. UMN has done another study for "outpatient" (that is, not hospitalized) treatment and sent the results for review. I'm not expecting any different results than from this one, but we'll know soon enough. The RECOVERY study is also studying azithromycin, a drug commonly administered with HCQ when used against this disease. It would be ironic if that one proves to be effective (study is still ongoing).
  - m4r35n357 6y ago
    It was only ever a con, perpetrated by corrupt politicians.
  - cheaprentalyeti 6y ago
    Are you referring to the retracted Lancet study or the just-breaking-news about the Oxford Recovery Trial where they were using lethal dosages of the drug? [1] [1] http://covexit.com/recovery-covid-19-research-blasted-for-toxic-dosage-towards-oxfordgate/ http://covexit.com/recovery-covid-19-research-blasted-for-to...
    - rsynnott 6y ago
      This seems to be the response to every trial that shows chloroquine and friends to be ineffective, though. "Well, of course there was no positive effect, the dose was too low." "Well, of course there was no positive effect, the dose was too high". "Well, of course there was no positive effect, you didn't tape a halibut to the patient's head". "No, not a cooked one, you fools, a live one!" At a certain point, it's possibly worth considering that there may be no there there.
      - jcranmer 6y ago
        I've noticed on Derek Lowe's blog that there seems to be a definite hydroxychloroquine brigade that doesn't exist for any other purported therapy. And as you noticed, this brigade will pick apart HCQ studies for not doing X for a bajillion different varieties of X. (Not simultaneously dosing with zinc and/or azithromycin is the one that tends to be mocked the hardest on the blogs).
      - jbritton 6y ago
        Here is a preprint that shows HCQ plus Zinc is effective. My knowledge on this matter comes only from watching a few YouTube videos. From that it has seemed all along that the treatment required is HCQ + Zinc. Zinc is what stops viral replication and HCQ helps get Zinc into the cells. So why are so many trials not using Zinc. https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1 https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v...
      - downerending 6y ago
        Before any of the studies came out, I was reading anecdotes specifically stating, "this only works with zinc". Which is not that hard to believe, from a biochemical perspective. Apparently most or all of the studies do not include zinc. Hooray.
  - rsynnott 6y ago
    The same trial found hydroxychloroquine not to be effective, and patients are no longer being enrolled in that arm of the trial: https://www.recoverytrial.net/files/hcq-recovery-statement-050620-final-002.pdf https://www.recoverytrial.net/files/hcq-recovery-statement-0...
  - vibrio 6y ago
    I'd not start dropping HCQ like candy. Beyond the retracted COVID study, it is established that there are risks associated with HCQ usage. use can lead to cardiomyopathy, prolong QT interval and trigger arrhythmia. source: drop chloroquine cardiomyopathy into pubmed or google scholar.
    - nerdponx 6y ago
      There's quite a spectrum between "HCQ is dangerous and ineffective for Covid-19" and "drink fish tank cleaner".
      - vibrio 6y ago
        I agree with you that "dangerous" isn't binary. To be clear, the medical literature I was referencing are focused on medical grade HCQ. I apologize that I was glib in my "like candy" comment. I'm reacting strongly to this topic because the current level of pop-culture medical expertise, partiuclary around HCQ and also vaccines, is concerning to me.
  - Symmetry 6y ago
    We've been dosing people with hydroxychloroquine for malaria for years so it would be very surprising if it suddenly turned dangerous. It's pretty clear at this point from a number of randomized trials that giving it to people who have developed Covid-19 isn't particularly useful. It's still possible that it might be useful prophylacticly, there's been some promising non-RCT studies coming out of India and at least one RCT underway, but I'm not sure I'd bet on it. EDIT: And to be clear the Indian studies suggested you wanted to be taking it for weeks before first exposure to SARS-2.
    - wbl 6y ago
      It's always dangerous. It has a black box warning for arrhythmia.
    - Nursie 6y ago
      > it would be very surprising if it suddenly turned dangerous https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/009768s037s045s047lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/00... Just because something is a useful medicine that's been given for a while doesn't mean it can't also have serious side effects, some of which could conceivably exacerbate Sars-CoV-2. Or not, there's no evidence that it does. But a lot of medicines are "dangerous", including Plaquenil, particularly if applied for the wrong circumstance or given to people with contraindications.
  - Nursie 6y ago
    > Or did we never get confirmation that it was effective? The reverse, there's confirmation it's ineffective. It may not be dangerous (I don't know) but it's no longer allowed as treatment in the US as the evidence has shown it's not useful. Can we stop talking about this and move on yet? It was only ever really of interest because Trump was flailing about for anything to make it look like he had a plan earlier in the year.
    - gfodor 6y ago
      No, there was interest because this was used in South Korea. Then, trump said a thing, everyone lost their minds, studies were rushed, the press lied about intermediate statistically-insignificant results, and it was a complete embarrassment to the medical community. The politicization of a medicine has been one of the stupidest things I’ve ever seen in my lifetime.
      - Nursie 6y ago
        > The politicization of a medicine has been one of the stupidest things I’ve ever seen in my lifetime. Couldn't agree more. It's insane that medical science gets turned into a partisan pissing match.
      - pjc50 6y ago
        > The politicization of a medicine has been one of the stupidest things I’ve ever seen in my lifetime. This seems to have been going on since Wakefield and the anti-vaxers; and one of the big reasons for rejecting chloroquine was exactly that it was being promoted by a whole infrastructure of dodgy quack websites. Which is undoubtedly where Trump got the idea from.
    - WillPostForFood 6y ago
      It may not be dangerous (I don't know) but it's no longer allowed as treatment in the US This is not true. It is still allowed as a treatment, and there are still studies going on using it in the US. The FDA emergency approval has been removed, which is more of a technical status. You can no longer acquire it from the government stockpile, and it is no longer recommended.
  - hannob 6y ago
    We never got confirmation that it was effective. All the early studies that indicated some effectiveness were basically garbage. The french study that caused most hype was flawed in multiple ways. The fact that a study showing its ineffectiveness was retracted is not evidence of the opposite.
  - SomeoneFromCA 6y ago
    Chloroquine (not hydroxy, good old chloro) is used in Central Asia. Death rate is pretty low (less than 10 per million), if you trust official media source of the countries in the region.
  - marcosdumay 6y ago
    There was more than one study that found HCQ dangerous. None had a clear effect. AFAIK, at this point we can't tell if it has a very tiny positive effect or a small damaging one. None are good news, so why push it further?
- zaroth 6y ago
  > For patients on ventilators, it cut the risk of death from 40% to 28%. For patients needing oxygen, it cut the risk of death from 25% to 20%. But I would guess that the survival rate for patients who don't require oxygen must be pretty damn high to start with.
  - barbegal 6y ago
    From the released statement: > Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).
    - zaroth 6y ago
      I wonder what 13% of people are dying from with COVID if it isn’t SARS...
      - orwin 6y ago
        Ive heard its heart attack.
        S_A_P 6y ago
        Most likely this. Low blood oxygen stresses the cardiovascular system so there are greater odds that anything that can go wrong there will.
      - nradov 6y ago
        Cytokine storm syndrome https://www.sciencedaily.com/releases/2020/05/200513081810.htm https://www.sciencedaily.com/releases/2020/05/200513081810.h...
        knowaveragejoe 6y ago
        This, as well as Disseminated Intravascular Coagulation(DIC). https://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation https://en.wikipedia.org/wiki/Disseminated_intravascular_coa... https://emcrit.org/ibcc/covid19/#disseminated_intravascular_coagulation https://emcrit.org/ibcc/covid19/#disseminated_intravascular_...
- heisenbit 6y ago
  Two other treatments with results - low dose of blood thinner (also significant improvement and widely available) - IL-6 inhibitor tocilizumab (some improvement in severe cases but expensive and hard to scale up) Both dexamethasone and tocilizumab weaken the immune system. Helps against the overshooting but risks other infections.
  - sp332 6y ago
    Do you have some links to news about these?
    - heisenbit 6y ago
      If you want to follow Reddit r/COVID19 is regularly posting preprints and has quite a number of professionals in the comments.
  - CWuestefeld 6y ago
    I've seen small observational studies with positive results about other IL-6 and TNF-a inhibitors, like Remicade. I have a particular interest in this because of Crohn's Disease - might the disease be making me high risk, and might my treatment (Entyvio, which operates differently from Remicade and its kin) help offset that anyway?
- JadeNB 6y ago
  > it was done against standard of care (so it can mean a lot of things) This looks like a technical phrase, and the parenthesis suggests that its meaning or implications should maybe be obvious, but they aren't to me! Do you mind elaborating?
  - lbeltrame 6y ago
    "Standard of care" basically means "whatever the current protocol to treat the disease is" (normally it means "the accepted treatment", but there isn't one yet), which can mean just trying to keep the fever down, supplementation of fluids, but also administration of drugs (with the exception of the one tested, of course). As you can imagine, it is quite variable in what it means, because it varies across countries and occasionally even hospitals (I'm sure the RECOVERY people have taken this into account, though). It is different from a placebo study because in that case your control is something you know is inert and "does nothing".
    - JadeNB 6y ago
      Thank you!

amelius 6y ago

> A cheap and widely available drug called dexamethasone can help save the lives of patients who are seriously ill with coronavirus. Yes, cheap until it gets patented because that is what usually happens when a drug is repurposed.

m4r35n357 6y ago
Just let them try! ;)
Mvandenbergh 6y ago
Using dexamethasone (an anti-inflammatory drug) to reduce inflammation is not patentable.
ringwalt 6y ago
Glucocorticoids are very old drugs. If there were a new patent at this stage in the US, it would be a combination drug or delayed release oral form ([source](https://www.patentdocs.org/2018/09/patenting-repurposed-drugs.html) https://www.patentdocs.org/2018/09/patenting-repurposed-drug...). There's also a dozen alternative generic analogues. There's already a [markup](https://www.washingtonpost.com/news/wonk/wp/2018/06/19/the-growing-case-against-iv-tylenol-once-seen-as-a-solution-to-the-opioid-crisis/ https://www.washingtonpost.com/news/wonk/wp/2018/06/19/the-g...) for very common drugs in IV form, which is bad, but unfortunately it's a very small part of the ICU bill to begin with in the US.
aroch 6y ago
Given that it was discovered in the 1950's, I don't think you're going to see a patent on the versions currently being used in clinic. Now,if someone creates a more bio-available/active functionalized variant of it, fine that might get patented. But I doubt it would have much of an impact on the suggested COVID19 treatment (and would likely be years away from market)
- kgwgk 6y ago
  You can actually get patent protection on things like dosage and indications. But it's much weaker than for composition-of-matter patents and often courts rule in favor of challengers.

danans 6y ago

This is good news, but it doesn't change anything from a public health perspective, because: > Of those who are admitted, most also recover but some may need oxygen or mechanical ventilation. > And these are the high-risk patients dexamethasone appears to help. At best this might take a little bit of pressure off the healthcare system in the treatment of the most severe cases. As others pointed, steroids are powerful/dangerous stuff so they won't be using this except in the most advanced cases.

jpxw 6y ago
I’m not sure if the low-dose dexamethasone treatment really is that “dangerous”, frankly. Steroids do have side-effects, but this drug is quite well-known and used frequently. Under medical supervision, and especially if the dosage is low, it seems likely it will be safe.
rsynnott 6y ago
I mean, most people who are dying receive oxygen and/or ventilation. If it does significantly reduce death rate there, that's not nothing.
- danans 6y ago
  Definitely not nothing. My point is that this treatment, however effective, isn't effective early enough in the disease's progression such that it allows us to reduce public health response measures by any significant amount, whereas a treatment that was very effective at an earlier stage of the disease would.
  - rsynnott 6y ago
    Oh, yeah, definitely. Such a treatment would be a game changer, and this one is not. Still, in the absence of such a treatment, this is very nice to have.

deleted 6y ago

[deleted]

nodesocket 6y ago

I’m a little frustrated that all the doctors seemed to have gotten this wrong. Using steroids was completely missed and ignored as a treatment for severe patients, as I understand dexamethasone was only shown to help people on oxygen or ventilators. It seems everybody was focused on covid being a respiratory disease, when in fact it looks like it’s actually circulatory.

rscho 6y ago
It was not missed. The recommendations during the first wave were to avoid corticosteroids because they were thought to be nefarious in this case. At least in Europe. Now we switched to the opposite. Behold, medical statistics the 8th world's marvel!
EGreg 6y ago
What do you mean it was missed? Corticosteroids were recommended to reduce the body’s overreaction. What I am wondering about is whatever happened to Ivermectin, that was so promising back in April. MERCK makes Stromectol since the 70s. Clears the entire infection in 48 hours! https://www.medicalnewstoday.com/articles/could-an-antiparasitic-drug-kill-off-sars-cov-2-within-2-days https://www.medicalnewstoday.com/articles/could-an-antiparas...
- rscho 6y ago
  European experts actively recommended not to give corticosteroids at the start of the pandemic and changed course late in the first wave. We had direct communication with those experts in my hospital and local guidelines didn't recommend steroids.
  - jfoster 6y ago
    Would be interesting to know what they based that on.
- sp332 6y ago
  *In cell cultures. It's in at least one trial. https://clinicaltrials.gov/ct2/show/NCT04374279 https://clinicaltrials.gov/ct2/show/NCT04374279 Estimated completion date is this month, so keep an eye out.

jcahill 6y ago

This is the RECOVERY trial. They have already likely killed patients through gross incompetence (see below). If you aren't asking the strongest lifesci researchers you know to read the fine print on every word coming from RECOVERY, you should draw no conclusions. How dare Landray even speak to the press at this point? From 2020-06-15: A large UK COVID-19 trial, the RECOVERY trial⁽¹⁾, likely killed patients with a 2400mg dose of hydroxychloroquine⁽²⁾ after one of its main authors confused hydroxychloroquine with hydroxyquinoline. This author was quoted in an interview by FranceSoir⁽³⁾⁽⁴⁾ on the topic and the project team is now running damage control, trying to claim that he was misunderstood etc. The amoebic dysentery answer in this exchange⁽⁵⁾ indicates the confusion with hydroxyquinoline and the "six to ten times" answer removes plausible deniability with respect to the administration of lethal dosages. ¹ https://recoverytrial.net https://recoverytrial.net ² https://threadreaderapp.com/thread/1272209860512419840.html https://threadreaderapp.com/thread/1272209860512419840.html ³ http://covexit.com/recovery-covid-19-research-blasted-for-toxic-dosage-towards-oxfordgate http://covexit.com/recovery-covid-19-research-blasted-for-to... ⁴ http://www.francesoir.fr/politique-monde/interview-exclusive-martin-landray-recovery-hydroxychloroquine-game-over-uk http://www.francesoir.fr/politique-monde/interview-exclusive... ⁵ https://files.catbox.moe/s9qc7v.png https://files.catbox.moe/s9qc7v.png

jcahill 6y ago
Here is the relevant file to comb over for today's dexamethasone result: ⁶ https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf https://www.recoverytrial.net/files/recovery_dexamethasone_s... Relevant passage: > A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%). Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14). Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone. Given the public health importance of these results, we are now working to publish the full details as soon as possible.

Tenoke 6y ago

As far as I can tell it is extremely common to give steroids (and dexamethasone is among the default choices) in those cases already. I can't quite tell but it doesn't sounds like it was compared to other steroids so I would hold judgement before we hear more. At any rate, hype over initial briefly reported findings is rarely useful. Edit: I was checking how common was it to give corticosteroids before the trial (pretty common as I suspected) but it's almost amusing that the WHO was recommending not to use it[0]. I wonder if this will be yet another miss for them. 0. https://www.contagionlive.com/news/is-there-any-reason-to-use-corticosteroids-in-coronavirus-treatment https://www.contagionlive.com/news/is-there-any-reason-to-us...

newacct583 6y ago
> it's almost amusing that the WHO was recommending not to use it Why is everyone picking on the WHO constantly? It's like it's a reflex at this point, as far as I can tell designed to shift "blame" off of... other parties who got lots of stuff wrong. In this case you're spinning really hard. The WHO guidance you're quoting, quoted in the article you link, was really mild: "“Given lack of effectiveness and possible harm, routine corticosteroids should be avoided unless they are indicated for another reason,” WHO authors wrote." Is that really unreasonable? In January they didn't have evidence of effectiveness, and drugs have side effects. Sounds like correct reasoning to me. Do you actually disagree? And in any case that quote is from a document in January, the current version (from March, also linked from the article) is here, and makes a bunch of complicated points about steroid use, citing contemporary research which was inconsistent about effect: https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf https://www.who.int/docs/default-source/coronaviruse/clinica...
- Tenoke 6y ago
  >Why is everyone picking on the WHO constantly? Because they've made multiple avoidable bad calls. >In this case you're spinning really hard. 'WHO was recommending not to use it' is a quick summary of statements like "routine corticosteroids should be avoided unless they are indicated for another reason,”. How is this not a recommendation against it and 'spinning really hard'? At any rate, I didn't dig into that part much (WHO recommendations are much much less important than medical trials), I just found it interesting enough to mention.

csomar 6y ago

Dexamethasone is a serious drug and corticosteroid [1]. It was prescribed for a friend after eye-surgery and having skin / eye inflammation problems, I used it (with no doctors advice) recklessly albeit with very small quantities. The drug was hyper-effective. An unbelievably tiny quantity can remove any inflammation (eye, skin, hair skin rash, etc...). But the fall out and side-effects are no joke even for seemingly super minuscule doses. It was a horror story for me with horrible eye inflammation, small inflammations in different parts of the body and a skin rash I still struggle with until today. Mind you I took small localized doses and not an injection. I wasn't aware that it can travel through your skin, get into your blood and make a mess. I think the research will need to specify potential side-effects and their probabilities. It's trade-off at the end of the day. PS: Do not ever think of trying it without medical advice and doctor supervision. [1]: https://en.wikipedia.org/wiki/Dexamethasone#Adverse_effects https://en.wikipedia.org/wiki/Dexamethasone#Adverse_effects

ceejayoz 6y ago
To be clear, it's generally advisable to only take a prescription drug under the direction of a doctor. This isn't unique to dexamethasone. Steroids plus eyes can lead to glaucoma. My doc won't let me use them anywhere near the face.
- cactus2093 6y ago
  Random aside - I wish I had a tough love doctor that would tell it to me like it is, and pay close enough attention to refuse to let me do things. I don’t even really use the term “my doctor”, I just see a doctor when I need to. I’m 30 and live in a large city, and I’ve rarely seen the same doctor more than a couple times in a row. I go in for a physical roughly once a year, and the doctor will sit and talk with me for 10 minutes or so. But otherwise if I need something checked out in between I often get seen by a PA or whatever doctor in the practice is free. I’ve never really felt encouraged by the same doctor to see them repeatedly, or to email them personally if I have a medical question like I know some people do. So when I move to a different neighborhood or something, I just end up seeing a different doctor next time. Am I just getting bad doctors? How do you find this type of buddy doctor that becomes a long term relationship and really cares about you personally, like I hear about other people seeming to have.

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userbinator 6y ago

This doesn't seem all that surprising --- I recall reading that steroids were also the choice of treatment for SARS many years ago.

acallaghan 6y ago
That's probably why they tested it?

axegon_ 6y ago

I only knew of Dexamethasone as cancer treatment. Which intuitively makes me wanna question how good of an idea this is. That said, my knowledge on medicine outside the sheer basics is practically none... I mean correct me if I'm wrong here but aren't cancer treatment drugs prone to cause severe side effects in general?

vajrabum 6y ago
Dexamethasone is not cancer specific. It is used in cancer treatment but mostly to reduce swelling and the effects of tumors. It doesn't have the side effects of chemo. It has its own set of problems it brings with the benefits.
_nalply 6y ago
I know of Dexamethasone as an anti-emetic for chemotherapy. It doesn't treat cancer but treats one side-effect of chemotherapy. It seems to be so helpful such that it enables some forms of chemotherapy not possible before. It seems weird to use a corticosteroid as an anti-emetic but I have seen with my own eyes that it is helpful.

christefano 6y ago

I thought that name was familiar. It’s the miracle drug called “dex” and hyped in the Chris O’Donnell movie, Vertical Limit. My bet is Vertical Limit is the next movie to trend (after Contagion): https://en.m.wikipedia.org/wiki/Vertical_Limit https://en.m.wikipedia.org/wiki/Vertical_Limit

improbable22 6y ago
Haven't seen the movie but it is one of the drugs prescribed for altitude sickness. Or rather, one of the ones often carried for use in life-threatening cases.
dilyevsky 6y ago
It’s routinely taken for prophylaxis and treatment of hape/hace by high altitude mountaineers (and not just because of the film)

aazaa 6y ago

More informative article here: https://www.statnews.com/2020/06/16/major-study-finds-common-steroid-reduces-deaths-among-patients-with-severe-covid-19/ https://www.statnews.com/2020/06/16/major-study-finds-common... The problem is that there is little more than a press announcement at this point. There are no data. There is no paper. There are no details to consider. We've seen this movie before, and it's gone badly (remdesivir, hydroxychloroquine). Safe and effective drugs require copious details, and you'll find none of them here.

selimthegrim 6y ago
What's bad about remdesivir?
- SmkyMt 6y ago
  "The most common adverse effects in studies of remdesivir for COVID‑19 include respiratory failure and organ impairment..." —wikipedia entry
  - delecti 6y ago
    That sounds more like "sometimes it doesn't work" than "sometimes it extra kills you".
- WhompingWindows 6y ago
  It's simply not that effective, it has a very small treatment effect and isn't a great tool, but it's certainly much more justifiable than hydroxychloroquine, which took much of the oxygen out of the room when POTUS and the GOP hyped it FAR beyond its statistically shown merits.
  - amluto 6y ago
    Also: it has serious manufacturability issues, and it can only be administered by IV. It’s entirely plausible that giving remdesivir to COVID-19 patients when they first show symptoms would make a big difference, but it’s impractical.

ReticentVole 6y ago

If this cuts deaths by 1/3rd, isn't that totally sufficient to end all lockdowns and border restrictions immediately? The death rate looks basically like the annual flu with this drug, particularly when we consider that it will just be one bad season then fairly minor from then on, when much of the population gets natural immunity.

mrlala 6y ago
It's baffling that you are comparing the death rate that happened DURING A LONG LOCKDOWN with a non-lockdown annual flu death rate.. and acting like if we can drop the numbers a bit it's the same thing. Your logic is essentially saying the lockdown did nothing to reduce deaths/infection.
- jeffreyrogers 6y ago
  They are talking about the death rate, not the absolute number of deaths.
  - rsynnott 6y ago
    I mean, that would still be wrong. IFR for flu is about 0.1% in a normal year. Most reputable estimates for the IFR for COVID are about 1%.
    - ReticentVole 6y ago
      CDC estimated it at 0.26%: https://in.dental-tribune.com/news/new-estimate-by-the-cdc-brings-down-the-covid-19-death-rate-to-just-0-26-as-against-whos-3-4/ https://in.dental-tribune.com/news/new-estimate-by-the-cdc-b...
      - rsynnott 6y ago
        That estimate wasn't particularly well-received, and the facts on the ground make it look especially dubious. NYC has has 17k deaths, for instance, mostly in April and early May. If you assume that _everyone_ in NYC has been infected, that would be an IFR of 0.2%. An antibody survey in late April found a prevalence of about 25% in New York City, which, assuming it's accurate (huge assumption, obviously) would indicate a rate of about 0.8%.

mbostleman 6y ago

Dex is an important part of a first aid kit for high altitude mountaineering as it's somewhat unpredictable who will be afflicted by various issues related to altitude or when.

JoeAltmaier 6y ago

This drug may be a hammer, and a better tool is desirable. But finally, a hammer that may work! I am hopeful this will move us faster along the direction of normalizing.

parasubvert 6y ago

I had idiopathic acute pericarditis several years ago with two months of anti inflammatories keeping it in check, but ultimately 3 days of low dose dexamethasone finished the job. My case was thought to be autoimmune - similar to the cytokine storm spoken of with COVID-19. Very effective and potent steroid.

f0ok 6y ago

Where is the study?

teknopaul 6y ago

How does this information "About 19 out of 20 patients with coronavirus recover without being admitted to hospital. Of those who are admitted, most also recover but some may need oxygen or mechanical ventilation." Get said along side a published ~10% death rate. There have 300,000 cases in the UK and 40,000 deaths.

PureParadigm 6y ago
It's possible there are more than 300,000 cases, since not everyone with the virus gets tested, so you can't assume 40,000/300,000 is the true death rate. There are likely many with milder symptoms who do not get tested and recover without going to the hospital, so the true death rate is lower than the confirmed deaths/confirmed cases figure.
jjjensen90 6y ago
There is no "death rate" metric. There is CFR (case fatality rate) and IFR (infection fatality rate). We know that there are many more infections than known cases, and serological studies point to total IFR <1%, with massive stratifications by age (<50 having extremely few fatalities, and >50 having increasing IFR every age bracket).
GuB-42 6y ago
The best estimate, based on New York data, puts the death rate at 1.4% [1] The number of cases in the UK is likely to be underestimated by a factor of 10 because it only takes into account cases confirmed by testing, and not everyone is tested, especially not mild/asymptomatic cases. This is consistent with several other studies in various places. [1] https://www.worldometers.info/coronavirus/coronavirus-death-rate/ https://www.worldometers.info/coronavirus/coronavirus-death-...

hcarvalhoalves 6y ago

Isn't administration of (potent) steroids the standard treatment for autoimmune reactions - what seems to happen on the extreme cases of COVID - already?

thehappypm 6y ago
It’s done commonly, but steroids are such a broad field of medicine that it’s almost like saying “don’t doctors already prescribe chemicals?”

dzink 6y ago

The title is click-bait. This and other steroids have been used by doctors against COVID-19 from the beginning. So have blood thinners, and plenty of other medications, and even radiation. From what has been gathered so far, COVID leads to an attack on the endothelial layer of your blood vessels that is responsible for clotting. That causes potentially permanent damage and if immunity doesn't last long, also potentially accumulating cardiovascular, pulmonary, and renal damage. From there COVID or the body's immune response can hit multiple organs at different times turning your life into a flimsy house of cards. Medicines for one organ can kill another (blood thinner targeting a clot in your body can and does cause a stroke, or some other issue). Just like a little push of the gas pedal or the breaks. The driver's (your doctor's) skill is far more important than a single medicine at this point.

jryle70 6y ago
NYT seems to think it's a big deal [0] > Assuming that when it goes through peer review it stands — and these are well-established researchers — it’s a huge breakthrough, a major breakthrough,” said Dr. Sam Parnia, a pulmonologist and associate professor of medicine at the Grossman School of Medicine at New York University. [0] - https://www.nytimes.com/2020/06/16/world/coronavirus-live-updates.html?action=click&pgtype=Article&state=default&module=styln-coronavirus&region=TOP_BANNER&context=storylines_menu#link-2c3ace49 https://www.nytimes.com/2020/06/16/world/coronavirus-live-up...

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