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Medicine

'Coronavirus: Dexamethasone Proves First Life-Saving Drug' 132

Posted by msmash from the moving-forward dept.
Dr_Ish shares a BBC report: A cheap and widely available drug can help save the lives of patients seriously ill with coronavirus. The low-dose steroid treatment dexamethasone is a major breakthrough in the fight against the deadly virus, UK experts say. The drug is part of the world's biggest trial testing existing treatments to see if they also work for coronavirus. It cut the risk of death by a third for patients on ventilators. For those on oxygen, it cut deaths by a fifth. Had the drug had been used to treat patients in the UK from the start of the pandemic, up to 5,000 lives could have been saved, researchers say. And it could be of huge benefit in poorer countries with high numbers of Covid-19 patients. The UK government has 200,000 courses of the drug in its stockpile and says the NHS will make dexamethasone available to patients. Prime Minister Boris Johnson said there was a genuine case to celebrate "a remarkable British scientific achievement", adding: "We have taken steps to ensure we have enough supplies, even in the event of a second peak." Chief Medical Officer for England Prof Chris Whitty said it would save lives around the world.
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'Coronavirus: Dexamethasone Proves First Life-Saving Drug' More

'Coronavirus: Dexamethasone Proves First Life-Saving Drug'

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  • Another "breakthrough" (Score:4, Interesting)

    by thatseattleguy ( 897282 ) on Tuesday June 16, 2020 @01:59PM (#60189734) Homepage
    It cut the risk of death by a third for patients on ventilators. For those on oxygen, it cut deaths by a fifth...
    .

    Don't get me wrong: since this drug is cheap and widely available, if it helps anyone at all, it's a win. But another way to put the above result is:

    for patients on ventilators, two-thirds saw no improvement; for those on oxygen, it cut the risk of death by just 20%

    That hardly seems the "breakthrough" we're all so desperately hungry for.

    • It is a breakthrough nonetheless, just check the definition.

      The information about dexamethasone is "important" and that alone is enough to meet the definition of "breakthrough".

      So get off your soap box Debbie!

      • Rub a dub dub
        Three COVIDs in a tub
        And who do you think were there?
        The antivaxer, the app-tracker, and the medical-nay-sayer
        All of them gone to the fair

    • If they can find a few drugs with this kind of efficacy and are able to create a "cocktail" where the effects are combined, then you probably will have something closer to a magic bullet.
      • This is definitely true.

      • You mean like zinc supplements, azithromyacin, and remdesivir?

        • Re: (Score:2)

          by Kaenneth ( 82978 )

          Toss in some natural anti-inflammatory like Turmeric, and Vitamin-D which probably does nothing... but it's cheap and safe.

          • Yeah I'm gonna guess that the vitamin-d suggestions have been bunk but I take it anyway (with zinc and turmeric) when going out these days.

      • Re: (Score:2)

        by rtb61 ( 674572 )

        Probably should take a close look at eucalyptus oil and tea tree oil, for the most effective active ingredients, to see how they can more effectively treat the symptoms of a lung infection. The patient can in the majority of instances fight off any infection, if the impact of the symptoms is mitigated sufficiently to allow immune system to catch up to the infection and defeat it. Sometimes just focusing in on treating the symptoms is the way to go, especially when the body can defeat the infection given the

    • I posted my take a mite too fast. The accurate (and more literate) reversal of the study's findings would be:

      .
      for patients on ventilators, two-thirds got no benefit and still died; for those on oxygen, 80% got no benefit and still died. So, for the large majority of the sickest patients, the drug was useless.

      • Re: Another "breakthrough" (Score:5, Insightful)

        by mr100percent ( 57156 ) on Tuesday June 16, 2020 @02:09PM (#60189784) Homepage Journal

        Thatâ(TM)s not uncommon, not every drug is 100% effective.

        Tamiflu was only around 20% effective at treating Bird Flu, but it was better than nothing.

      • Precise. (Score:5, Insightful)

        by DrYak ( 748999 ) on Tuesday June 16, 2020 @02:23PM (#60189872) Homepage

        for patients on ventilators, two-thirds got no benefit and still died;

        2/3 of patients on ventilators that would have died any way still died even with the drug.
        1/3 of patients on ventilators that would have otherwise died didn't die if given the drug.
        Or in other word, the drugs saves more lives.
        Without drug: 40% die.
        With drug: 28% only die.
        This reduction of death is deemed significative.

        for those on oxygen, 80% got no benefit and still died.

        80% of patients on oxygen that would have died any way still died even with the drug.
        20% of patients on oxygen that would have otherwise died didn't die if given the drug.
        Or in other word, again: drugs instead of no-drug saves more lives.
        Without drug 25% die.
        With drug only 20% die.
        This reduction of death, too is significative.

        So, for the large majority of the sickest patients, the drug was useless.

        The effect is small, but it's clearly present. You won't save everyone but you do save lives.
        For each 8 patients on ventilator that you treat, you save one more extra life thanks to the drug, than those who would have otherwise recovered.
        For each 20 patients on oxygen that you treat, you save one more extra life thanks to the drug, than those who would have otherwise recovered.

        Small effect, but clearly positive effect.
        Unlike other drugs like HCQ which eventually don't have any remarkable beneficial effect.
        So it's a breakthrough because we finally have something that shows sign it might actually work (of course: pending publication, peer reviewer, ... even replication elsewhere).

        • Similar situation: A large percentage of people who get CPR die anyway. A very large percentage, much more than 2/3. So should we not bother with CPR at all?

      • Sigh.

        for patients on ventilators, two-thirds got no benefit and still died

        The claim of 33% is across all patients. So yeah, stats. Some groups will respond better, and some worse. And, this is the shocking part, for any potentially mortal ailment, the sickest patients have the highest mortality.

        Keep spreading the truth brother.

      • Re:Another "breakthrough" (Score:5, Insightful)

        by tragedy ( 27079 ) on Tuesday June 16, 2020 @03:39PM (#60190136)

        I really just can't even understand the thought processes behind comments like this. There are currently about 119,000 Coronavirus deaths in the US. If we'd had this treatment from the start, it would have saved something like 30,000 people, and here you are saying that 81,000 people would have still died so there's no benefit. The US is due about another 80,000 deaths before October. Applying this across the board looks like it will therefore save another 20,000 lives in that timeframe. Why are people this bad at relating the math to the actual thing in the real world that it models?

        • Re:Another "breakthrough" (Score:4, Insightful)

          by im_thatoneguy ( 819432 ) on Tuesday June 16, 2020 @04:14PM (#60190290)

          The maddening part of this will be the numbskulls in October saying:

          "The models in May said 80,000 people would die, but only 60,000 died. Once again, the scientists and models are wildly wrong again!" while ignoring the contribution of effective therapies not accounted for in the models because... how would they know?

        • Re: (Score:2)

          by Kaenneth ( 82978 )

          Because they only care about one life, their own.

        • Re: (Score:2)

          by ceoyoyo ( 59147 )

          Our monkey brains are incredibly bad at math, particulary risk assessment. It's nothing new.

    • Depends it is a 20% reduction in death rate if your in oxygen, which has quite a high survival rate any way. It's 33% if you are on a ventilator which has a low survival rate. This is the first drug actually proven to reduce death rates in COVID-19 patients which makes it a breakthrough. Unlike rubbish being peddled by orange man.

      • Re: (Score:2)

        by dgatwood ( 11270 )

        Depends it is a 20% reduction in death rate if your in oxygen, which has quite a high survival rate any way. It's 33% if you are on a ventilator which has a low survival rate. This is the first drug actually proven to reduce death rates in COVID-19 patients which makes it a breakthrough. Unlike rubbish being peddled by orange man.

        Depends on your threshold for "proven". I would say that it's at least the third known life-saving drug.

        The first was famotidine. A month ago, a retrospective cohort study of 1,620 patients [medrxiv.org] in New York found that patients given famotidine (a.k.a. Pepcid) while hospitalized died 58% less often than patients not given that drug, and that other drugs (PPIs) for heartburn did not show a statistically significant drop (i.e. this isn't a case of heartburn sufferers being less likely to die). This is also consi

    • Re:Another "breakthrough" (Score:4, Insightful)

      by LynnwoodRooster ( 966895 ) on Tuesday June 16, 2020 @02:27PM (#60189888) Journal
      It is a breakthrough for the 20% who didn't die... Isn't the mantra "if we save just one life"?

    • That hardly seems the "breakthrough"

      You should ask the 1 in 5 people whose life it saves what they think. In medical terms a 20% reduction in mortality is huge. At least part of the "breakthrough" is that it is cheap and readily available.

      IRL, progress is incremental.

    • Comment removed based on user account deletion

      • Johnson jumped on a bandwagon. It's what he's done all his life. We could argue about whether the incompetent UK gov deserve any credit for funding research - I'd say they understood there was no way to avoid it and stay in power, so no credit is due. Otherwise, breakthroughs were going to come, leeches like Johnson were going to leap in to claim credit as predictably as night follows day.

        What is sickening is claiming the UK gov deserve credit for approving dexamethasone use in cv19. Blatant theft of others

      • Re: (Score:2)

        by Cederic ( 9623 )

        Properly run medical trial proves positive; of course a national leader is going to be upbeat about it.

        If it helps any, the millionaire Sir Keir Starmer (the Leader of the Opposition in the UK) today stood in Parliament and welcomed this news too.

        It's almost as though an effective treatment is a good thing, irrespective of the politics of the person agreeing with that.

    • The mechanism of action for dexamethasone would be to counter cytokine storms (an autoimmune-like process). Cytokine storms (vs. the virus itself) are likely the biggest contributors to respiratory failure and other effects such as blood clots. It is routinely used for meningitis patients as they begin to recover. So, while dexamethasone does not have antiviral efficacy, it may in fact save many lives for the sickest patients.

    • Re: (Score:2)

      by AvitarX ( 172628 )
      This appears to save lives for about the cost of a seat belt per a life saved (same order of magnitude anyway).

      It will likely save 10,000 lives in the US alone over then next 6 months.

      Seems a pretty big breakthrough to me.

      Obviously not enough to make the problem go away, but going from 0 drugs to 1 drug that have a notable impact definitely seems like a breakthrough.
    • I like to think of it this way: if 100,000 have died in the US, this would have saved more than 5,000 lives and reduced the long term effects on survivors.

      We have to realize that recovery will be made by taking many small steps.

    • Featured snippet from the web
      The following side effects are common (occurring in greater than 30%) for patients taking dexamethasone:

      Increased appetite.
      Irritability.
      Difficulty sleeping (insomnia)
      Swelling in your ankles and feet (fluid retention)
      Heartburn.
      Muscle weakness.
      Impaired wound healing.

    • Re: (Score:2)

      by ceoyoyo ( 59147 )

      If you're hoping for a miracle cure, well, there's a reason those have "miracle" in the title.

      Cutting risk of death for critically ill patients by 1/3 is, frankly, almost unbelievably good.

    • 20% for something you can mass produce for pennies seems like a pretty good win. Not a hey let's hop on a COVID infested cruise ship win, but a win nonetheless

  • Good, randomized, trial (Score:5, Informative)

    by JoshuaZ ( 1134087 ) on Tuesday June 16, 2020 @02:10PM (#60189790) Homepage

    This was a properly done randomized trial. So unlike many early COVID related trials, this was not a retrospective trial and has data we can likely rely on. However, the study itself has not yet been published or peer reviewed which is a critical step. Note also that according to https://www.nature.com/articles/d41586-020-01824-5 [nature.com] the sample sizes were large. 2,100 people received the drug compared to 4,300 who did not. The dosages apparently varied, but were all at most six milligrams a day, which is a small enough quantity that severe risk of side-effects may be minimized.

    The drug does have some side-effects which are mostly long-term https://www.drugs.com/monograph/dexamethasone.html [drugs.com] so they might not be relevant here as much anyways. This is already a highly prescribed medication https://clincalc.com/DrugStats/Top300Drugs.aspx [clincalc.com] so it is very well-understood and reasonably safe. This is definitely not a magic bullet, but if this turns out to be correct could be a major reducer in mortality.

    • Death itself is a long-term effect as far as I know, so this is certainly welcome, but it's definitely not a magic bullet based on the information in the article:

      For patients on ventilators, it cut the risk of death from 40% to 28%.

      For patients needing oxygen, it cut the risk of death from 25% to 20%.

      Again, I'll take better odds even if they aren't great, but I have a feeling that this might get overhyped.

      • Had we known this back in March it would have saved 4000-5000 lives so far in the UK. That's a lot of people who could have been saved.

        • Re: (Score:2)

          by hawk ( 1151 )

          time travel is always useful that way :)

          But if we're going to play, "if we had known", then the thing to know would be that the ChiCom dictatorship was flat-out lying, and prohibiting all incoming flights from their territory . . .

          hawk

      • Re: (Score:1)

        by taustin ( 171655 )

        Anything with even vaguely positive implications will be overhyped.

        As will anything with even vaguely negative implications.

        It's like the news media isn't interested in the news, only in the overhyping.

        • Anything with even vaguely positive implications will be overhyped.

          That's nice. This doesn't fall into the "vague" category however.

          • Re: (Score:2)

            by taustin ( 171655 )

            But it does seem to fall into the "overhyped" category.

            • But it does seem to fall into the "overhyped" category.

              TFA, and the /. summary says exactly what it is. Numbers, data, and all. If someone gets overhyped about it, that's on them.

      • Re: (Score:2)

        by Nidi62 ( 1525137 )

        Death itself is a long-term effect as far as I know, so this is certainly welcome, but it's definitely not a magic bullet based on the information in the article:

        For patients on ventilators, it cut the risk of death from 40% to 28%.

        For patients needing oxygen, it cut the risk of death from 25% to 20%.

        Again, I'll take better odds even if they aren't great, but I have a feeling that this might get overhyped.

        Well, since the whole treatment costs roughly $50 per son, I'd say even a small percentage gain in survival rates is worth it.

        • Re: (Score:2)

          by hawk ( 1151 )

          >Well, since the whole treatment costs roughly $50 per son,

          I want to know the price per *daughter* before committing . . .

          I do have four of them, after all . . .

          hawk

    • I had some serious stomach pains after taking it just for four days. Never used it again for longer than one day after that. Beats dying though.
      It will only be helpful against an excessive immune response, but it's otherwise counterproductive against the coronavirus because it shuts down the immune system hence I hope people won't start taking it as prevention or cure by themselves.

  • An anthem worth singing
  • https://youtu.be/Hs0vZBOZufw [youtu.be] Goosebumps every time - everyone in UK "born in the NHS" means more than born in the UK...

  • Don't get too excited and stay vigilant (Score:4, Informative)

    by Joe2020 ( 6760092 ) on Tuesday June 16, 2020 @02:41PM (#60189944)

    The actual numbers are:

    For patients on ventilators, it cut the risk of death from 40% to 28%, or, 1 life saved for 8 treated patients.
    For patients needing oxygen, it cut the risk of death from 25% to 20%, or, 1 life saved for 20-25 treated patients.

    This is still a long way off from a cure. While it's good news, getting too excited can mean some people will think it's almost over and they start getting careless, which is not what we want.

    • The other thing we need to know is whether it ameliorates the damage done to organs - particularly lungs. It's barely discussed but surviving leaves many with probably life long conditions, all the way up to needing organ transplants.

  • As a lifelong asthmatic who has been treated with various steroids for decades, this doesn't seem all that surprising to me. I'm taking a burst of methylprednisolone right now, along my other inhaled steroids. Wheee....

    - Necron69

  • "Surgeon and public health researcher Atul Gawande tweeted:

    It will be great news if dexamethasone, a cheap steroid, really does cut deaths by 1/3 in ventilated patients with COVID19, but after all the retractions and walk backs, it is unacceptable to tout study results by press release without releasing the paper."

    Also:

    "Dr Penny Ward, an expert in pharmaceutical medicine and a visiting professor at King’s College London called the announcement “good news” in a statement but noted:

    C

  • Dexamethasone was first made in 1957 and was approved for medical use in 1961.[5][6] It is on the World Health Organization's List of Essential Medicines.[7] Dexamethasone is not expensive.[8] In the United States, a month of medication typically costs less than US$25.

    Wow, wonder how a drug that is almost certainly not under patent managed to slip through. (Yes, I'm that jaded.)

    • Re: (Score:2)

      by Cederic ( 9623 )

      NHS study in the UK.

      We look for effective treatments, not profitable ones.

      (Yes, I'm also cynical).

  • Cytokine storm ... (Score:3)

    by kbahey ( 102895 ) on Tuesday June 16, 2020 @03:51PM (#60190212) Homepage

    The fact that a corticosteroid helped some COVID-19 patients, points to cytokine storms as the culprit in complications and deaths, at least for a portion of the patients. Cytokine storms is when the immune system overreacts and that overreaction causes more damage than the pathogen itself.

    Read more about cytokine storms here:

    Into the Eye of the Cytokine Storm [nih.gov]

    Cytokine storm [newscientist.com]

    Cytokine release syndrome [wikipedia.org]

  • Not be confused with dextromethorphan, the dissociative anesthetic commonly found in cough suppressant medication in the US. Also uncommonly abused as a recreational substance by teenagers.

    I wonder how many idiots will swig a bottle of cough syrup to protect themselves from COVID-19, only to end up tripping. Of course, if it's a formulation with phenylephrine too, they may possibly have some cardiac issues, or at the very least some nasty vasoconstriction.

  • Dexamethasone helps because it reduces inflammation, which I hear is the big problem with COVID. Advil reduces inflammation, as does any other non-steroidal anti-inflammatory drug (NSAID). Are anti-inflammatory steroids the only ones strong enough, or might the common NSAIDs patients may already be taking to reduce fevers and associated aches and pains be enough for most?

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