Inexpensive steroid dexamethasone is the first drug to reduce deaths from covid-19
(WaPo)
Well, isn't that fabulous news!
LONDON — An inexpensive steroid reduced deaths from coronavirus infection, helping some of the sickest patients with severe lung damage survive the illness, according to British clinical trial results announced Tuesday in a news release.
The 60-year-old drug, dexamethasone, is the first medication shown to increase people’s chances of surviving covid-19, the disease caused by the novel coronavirus. It reduced the risk of death for patients on ventilators by a third and cut the risk of death for patients on oxygen by a fifth, heartening news that drew widespread interest and hope.
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Outside physicians tempered their optimism about the news with urgent calls to release details of researchers’ findings so doctors could pore over the data and understand the benefits and limitations of the drug.
“If this is reproducible and if it pans out, it’s a huge win — but that’s a lot of ‘ifs,’" said Isaac Bogoch, an infectious diseases specialist at Toronto General Hospital. “It’s cheap as borscht, as my grandparents would say. It’s widely available. Every single physician on the planet that practices hospital-based medicine is comfortable using this drug.”
But without complete data from the trial, physicians such as Bogoch are in a difficult predicament. Bogoch said that if a patient came into the hospital today with covid-19, he is not sure whether he would use the drug or when he would start it without more information. As of Tuesday afternoon, treatment guidelines from the World Health Organization and the National Institutes of Health recommended against using steroids because of the lack of evidence that the benefit of the drugs outweighs potential harm.
Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an interview Tuesday that a group of experts who craft guidelines on treating covid-19 is already planning to meet to evaluate the data and assess whether recommendations should be changed.
...The British investigators leading the trial said they chose the unconventional route of stating the results before providing additional data because of the public health importance.
The investigators estimated that dexamethasone could prevent one death in about eight ventilated patients or one death in about 25 cases in which patients required supplemental oxygen.
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But to physicians, it is yet another example of the difficulty of practicing medicine during the covid-19 era, in which scientific findings are routinely shared by news release, media report or preliminary studies that are not yet subjected to peer reviews that help identify shortcomings or flaws.
[Cold fusion, anyone?]
“I think that doctors are generally not going to change practice on a press release, no matter how promising it seems,” said Nahid Bhadelia, medical director of the special pathogens unit at Boston Medical Center.
“We always have a concern when we give steroids to patients in general, because steroids depress the immune system,,” Bhadelia said. “They carry the risk of making the current infection worse and increase the chance of another infection taking a foothold.”
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Outside physicians said it was important for people to understand that this was not a drug for people with mild symptoms or a cure for covid-19. The effects were seen in patients with severe lung damage — requiring supplemental oxygen or a ventilator.
