[lex24]

While Trump has distracted everybody with discussions of disproven therapies like hydroxychloroquine and possibly beneficial but unproven therapies like convalescent plasma (more on that, here: https://www.fiercepharma.com/pharma/rebu...-treatment), the one proven treatment has not been mentioned.  I'm not sure if it's because the ship has sailed already, and Trump saying it's a game-changer would be greeted by "we're already doing that" and a meh.  But I was reviewing some charts recently, and counted the proportion of patients on this cheap, readily available treatmemt, and just over 50% were, which means that half the patients didn't receive a therapy that could cut their risk of death by a third.

The treatment is corticosteroids.  I mentioned the outcome of the recovery trial earlier (https://www.nejm.org/doi/full/10.1056/NEJMoa2021436), which showed that dexamethasone reduced the risk of mortality by 17% (on a relative, not absolute basis; the absolute risk difference is 2.8%, which means that you save 1 life for each 38 people COVID patients you treat with dexamethasone.  The effect was most noticeable in the sickest patients; the relative risk of death in patients is 0.64 and the risk difference was 12.1%, so you would save 1 life for every 8 COVID-19 patients on mechanical ventilators treated with dexamethasone.

Of course, that was only one study, so it would be useful to see that replicated.  So, a new meta analysis published in JAMA is really helpful (https://jamanetwork.com/journals/jama/fu...le/2770279).  The study looked at 7 randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill patients with COVID-19 in 12 countries.  It included the recovery trial, which was the single biggest source of patients for the meta analysis, but the results were pretty consistent across studies and steroid types (dexamethasone, methylprednisolone, or cortisone).  I would still want to see at least one more well-powered study (multiple hundreds of patients) to confirm the Recovery trial findings, but if I had a patient in front of me with severe COVID requiring oxygen or (especially) if mechanically ventilated, I would not hesitate to put them on 5 days of dexamethasone.

It's as close to a game-changer as you can reasonably expect in this disease, and I wish the President would have touted it, instead of disproven or inadequately proven therapies.

BC

If Trump touted it, the effectiveness would drop and he’d be accused of preaching false hope.  Doesn’t stop others from touting it.  Why hasn’t it been?

[lex24]

While Trump has distracted everybody with discussions of disproven therapies like hydroxychloroquine and possibly beneficial but unproven therapies like convalescent plasma (more on that, here: https://www.fiercepharma.com/pharma/rebu...-treatment), the one proven treatment has not been mentioned.  I'm not sure if it's because the ship has sailed already, and Trump saying it's a game-changer would be greeted by "we're already doing that" and a meh.  But I was reviewing some charts recently, and counted the proportion of patients on this cheap, readily available treatmemt, and just over 50% were, which means that half the patients didn't receive a therapy that could cut their risk of death by a third.

The treatment is corticosteroids.  I mentioned the outcome of the recovery trial earlier (https://www.nejm.org/doi/full/10.1056/NEJMoa2021436), which showed that dexamethasone reduced the risk of mortality by 17% (on a relative, not absolute basis; the absolute risk difference is 2.8%, which means that you save 1 life for each 38 people COVID patients you treat with dexamethasone.  The effect was most noticeable in the sickest patients; the relative risk of death in patients is 0.64 and the risk difference was 12.1%, so you would save 1 life for every 8 COVID-19 patients on mechanical ventilators treated with dexamethasone.

Of course, that was only one study, so it would be useful to see that replicated.  So, a new meta analysis published in JAMA is really helpful (https://jamanetwork.com/journals/jama/fu...le/2770279).  The study looked at 7 randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill patients with COVID-19 in 12 countries.  It included the recovery trial, which was the single biggest source of patients for the meta analysis, but the results were pretty consistent across studies and steroid types (dexamethasone, methylprednisolone, or cortisone).  I would still want to see at least one more well-powered study (multiple hundreds of patients) to confirm the Recovery trial findings, but if I had a patient in front of me with severe COVID requiring oxygen or (especially) if mechanically ventilated, I would not hesitate to put them on 5 days of dexamethasone.

It's as close to a game-changer as you can reasonably expect in this disease, and I wish the President would have touted it, instead of disproven or inadequately proven therapies.

BC

If Trump touted it, the effectiveness would drop and he’d be accused of preaching false hope.  Doesn’t stop others from touting it.  Why hasn’t it been?