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posted by martyb on Sunday July 12 2020, @01:25AM   Printer-friendly
from the did-anyone-try-aspirin? dept.

Australian Health Protection Principal Committee (AHPPC) statement on preliminary media reports of the results of a randomised trial of the use of dexamethasone

AHPPC notes the preliminary media reports of the results of a randomised trial of the use of dexamethasone, a corticosteroid, in the management of hospitalised patients with COVID-19.

Whilst only a single trial, it appears to be a large well-conducted study. The investigators reported a significant reduction in mortality in patients on mechanical ventilation and in those requiring oxygen, but not in those with less severe illness. AHPPC notes that dexamethasone appears to reduce mortality, but mortality was still 29% in ventilated patients and 22% in patients on supplemental oxygen who were treated with dexamethasone.

Although this seems to be an exciting development, further examination of the scientific results, when published, will be required to confirm the efficacy of dexamethasone for severe COVID-19. It is likely that dexamethasone operates by reducing inflammation of the lung in severe disease, and thus would not be expected to be useful in the prevention of COVID-19.

The availability of this treatment doesn't reduce our need to prevent and control community transmission of COVID-19 as the mortality of severe COVID-19.

The University of Oxford issued a news release Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19:

In March 2020, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial was established as a randomised clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). Over 11,500 patients have been enrolled from over 175 NHS hospitals in the UK.

On 8 June, recruitment to the dexamethasone arm was halted since, in the view of the trial Steering Committee, sufficient patients had been enrolled to establish whether or not the drug had a meaningful benefit.

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.

Journal Reference:
Peter Horby, Wei Shen Lim, Jonathan Emberson, et al. Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report [$], medRxiv (DOI: 10.1101/2020.06.22.20137273)


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  • (Score: 0) by Anonymous Coward on Sunday July 12 2020, @03:05AM (2 children)

    by Anonymous Coward on Sunday July 12 2020, @03:05AM (#1019710)

    The results with Dexamethasone are encouraging. It seems to suppress the lung damage that can be caused by an excessive reaction by the immune system.

    In related news, Gilead claims that remdesivir also reduces the death rate [cnbc.com] versus standard treatments. Remdesivir is an antiviral and works by blocking the replication of the virus.

    This recent article [cnn.com] discusses a couple of other promising treatments that are currently being tested. One is a couple of new antivirals [sciencemag.org] that may be effective against SARS-CoV-2. The other is a monoclonal antibody treatment [sciencemag.org] that may be effective both in treating COVID-19 and could be effective in preventing infection.

  • (Score: 1, Insightful) by Anonymous Coward on Sunday July 12 2020, @04:40AM

    by Anonymous Coward on Sunday July 12 2020, @04:40AM (#1019727)

    Taking medical advice from CNN?

  • (Score: 0) by Anonymous Coward on Sunday July 12 2020, @06:51AM

    by Anonymous Coward on Sunday July 12 2020, @06:51AM (#1019765)

    Now to test them together. I suspect that for a few years, the standard of care may be a "Covid cocktail". The side effects will go down, and the effectiveness will go up as the cocktail is refined, just like it was for HIV. Of course it's better not to get Covid or HIV in the first place, so fingers crossed on the vaccine or even something like PrEP. If you give PrEP to people who interact with the public the most, that might be enough to achieve the same effect as herd immunity... but we're nowhere near having that for Covid yet, and it hasn't really stopped HIV either. There are HIV-idiots just like there are Covidiots. There are still 10s of thousands of new HIV infections each year in the USA and Europe, despite all the readily available prevention methods.