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: 2) by JoeMerchant on Sunday July 12 2020, @03:05AM (13 children)
By the time you need a cure, prevention is irrelevant...
COVID-19 apparently kills primarily via alveolar collapse. I'm surprised that it has taken this long for something like an anti-inflammatory to "come out" as a way to improve/speed healing and reduce mortality.
🌻🌻 [google.com]
(Score: 1, Insightful) by Anonymous Coward on Sunday July 12 2020, @03:59AM (3 children)
What I was wondering from the beginning is if there are any anti-inflammatory drugs that target the lungs in opposed to broad based anti-inflammatory drugs or ones that target something other than the lungs. Perhaps some of the inhaled steroid products or maybe something they use for asthma?
I figure a more targeted approach will have better results with a lower dosage and hence fewer side effects. Trying to use a non-targeted approach would require a stronger dosage which would have more side effects and be more dangerous.
(Score: 3, Interesting) by RS3 on Sunday July 12 2020, @04:09AM (1 child)
Just guessing here, but I'm pretty sure they would be using inhaled Albuterol and other lung inflammation reducers.
The trouble is, the immune system is fired up too much and needs to be calmed by the steroid before it gets to the lungs, so systemic treatment is actually indicated.
(Score: 1, Informative) by Anonymous Coward on Sunday July 12 2020, @06:05AM
A pneumologist I corresponded with said a similar thing. The primary system of advanced COVID-19 is low SpO2 and ARDS. But why? The answer is that your lungs are compromised, have fluid in them, the blood-air barrier is altered, there can be collapse of the alveoli, and patients can have sepsis or infection of other ACE2 cells. An inhaled corticosteroid can't reach the areas deep in the lungs or that have collapsed directly and has a more muted indirect effect.
I'd also like to point out that there is a difference between standard practice and informal/semiformal information sharing of anecdotes for treatments being changed and promulgated versus there being good studies saying the same.
(Score: 2) by c0lo on Sunday July 12 2020, @08:15AM
Dexamethasone [wikipedia.org]
There are no antiinflamatory that are so specific to act just on lungs. Not yet anyway.
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 0) by Anonymous Coward on Sunday July 12 2020, @06:57AM
Are you the same guy complaining about Polish hackers illegally fixing ventilators on the other thread? The FDA doesn't modify standards on the basis pf JoeMerchant's opinion on SoylentNews.com so they had to wait for actual testing and data. Sorry they didn't do it faster - you're the taxpayer and you are the boss, massah-sir.
(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
(Score: 2) by c0lo on Sunday July 12 2020, @08:19AM
Because one needs quite a number of infections to conduct randomized studies of this type. The likely places to discover medication/vaccines will be OECD countries with a large number of infections.
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 2) by EvilSS on Sunday July 12 2020, @05:45PM
(Score: 0) by Anonymous Coward on Sunday July 12 2020, @03:05AM (2 children)
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
Taking medical advice from CNN?
(Score: 0) by Anonymous Coward on Sunday July 12 2020, @06:51AM
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.
(Score: 2) by MostCynical on Sunday July 12 2020, @03:08AM
A UK Study [medicinenet.com]
"I guess once you start doubting, there's no end to it." -Batou, Ghost in the Shell: Stand Alone Complex
(Score: 0) by Anonymous Coward on Sunday July 12 2020, @07:01AM (5 children)
I'm a scientist by nature. So I've taken to drinking waaay the fuck more than usual. I hypothesize that this confers immunity to Corona virus. Hey, it's works soa faar.
(Score: 0) by Anonymous Coward on Sunday July 12 2020, @07:26AM
It's a good start, but we need to test more drugs. I'll get started on the LSD.
(Score: 2) by Kitsune008 on Sunday July 12 2020, @02:21PM (3 children)
That may actually work...if you can maintain BAC(Blood Alcohol Concentration) level that is high enough to act a a disinfectant.
Good luck with that. ;-)
(Score: 2) by c0lo on Sunday July 12 2020, @10:51PM (2 children)
Did you mean ABC (Alcohol Blood Concentration)?
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 2) by Kitsune008 on Monday July 13 2020, @05:18AM (1 child)
Yes.
At 70%+ BAC(or ABC if you wish), the coronavirus has not got a chance. There is a slight risk for some patients though, but at least they are already embalmed. ;-)
(Score: 2) by c0lo on Monday July 13 2020, @07:15AM
30% ABC more precisely.
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford