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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)
(Score: 1) by shrewdsheep on Sunday July 12 2020, @07:36AM (5 children)
One mayor reason might have been an initial recommendation by the WHO not to use corticosteroids. Why did they do it? They did not give any reasons, so it is probably smartassery on the part of an "outbreak response committee".
In general, I am a big proponent of corticosteroids which are among the most safe and effective drugs overall. If you feel bad during a cold, it is your immune system not the virus. If have taken corticosteroids at the beginning of a cold or as a general performance enhancer with excellent results. Just remember to take it in the morning (or you will not be able to sleep).
(Score: 2, Informative) by Anonymous Coward on Sunday July 12 2020, @08:51AM (4 children)
You feel ill because your immune system is doing its job. It's quite possible that Dexamethasone may actually increase the risk of serious infection in mild cases [nytimes.com] because it suppresses a proper immune response. The purpose of using a corticosteroid for severe COVID-19 cases is to suppress an immune response that is causing damage to the body. That's very different from suppressing the immune system when it's functioning correctly.
(Score: 1) by shrewdsheep on Sunday July 12 2020, @09:43AM (2 children)
This is a misunderstanding. It is a mistaken belief to think your immune system is fine-tuned and responds optimally to infections. It does not. There are sledge-hammer like molecules (like certain Prostaglandins) which promote inflammation and are regularly released upon infection. They cause the symptoms but the course of infection is unchanged in their absence. There are probably more than 100 indications to use corticosteroid in medical conditions. There is no other drug that even comes close.
(Score: 1, Insightful) by Anonymous Coward on Sunday July 12 2020, @10:49AM (1 child)
I always come to SoylentNews for the very best medical advice, and recommendations on investments. Everyone is amazed how smart Soylentils are, it almost like they took a cognition text!!
(Score: 0) by Anonymous Coward on Sunday July 12 2020, @11:07AM
Good for you. You are not alone!
(Score: 0) by Anonymous Coward on Sunday July 12 2020, @04:44PM
FTFY