Major breakthrough in treatment

[Redolent]

A cheap steroid has become the first life-saving treatment in the Covid-19 pandemic, described by scientists as a major breakthrough and raising hopes for the survival of thousands of the most seriously ill.

Dexamethasone is cheap, available from any pharmacy, and easily obtainable anywhere in the world. Investigators said the drug was responsible for the survival of one in eight of the sickest patients – those who were on ventilators – in the Recovery trial, the biggest randomised, controlled trial of coronavirus treatments in the world.

www.theguardian.com/world/2020/jun/16/steroid-found-to-help-prevent-deaths-of-sickest-coronavirus-patients

Apparently it would have saved the lives of 5000 of those who died in the UK.

Great start in terms of treatment. Some scientists are predicting an effective cocktail of (3 or so) drugs available by the end of the year. Onwards and upwards.

@TabbyMumz

Yes I understand it's been round for years, I just cant believe it's taken this long to announce its use. Surely most medics would have been using it all along? So when people say it could have saved 5000, how do we know it hasnt already,?

@TabbyMumz Why would medics have been prescribing a drug with no evidence of efficacy? We had to do the clinical trial first to prove or disprove its efficacy and safety. Remember two months ago people on here were pushing for hydroxychloroquine to be prescribed willynilly cos it was some sort of wonder drug? And then the trials showed it had worse outcomes than just giving nothing?

@TabbyMumz

Its brilliant news, however I cant help but wonder if they havent been using steroids from the beginning? And if not, why not?

This is a proper peer reviewed study based on over 1000 patients. Takes time to do and prove a benefit.

I'm wondering if this is why we have such a high death rate, because medics cant use drugs at their disposal because they could only use it on patients accepted onto the trial, specifically for use in covid. Whereas other countries,they arent restricted so much. As someone up thread said, their vet husband said that would be the first drug they went for? Have medics in the uK wanted to use it, but not been allowed?

@Randomschoolworker19

Great news.

According to BBC news we've banned it for export though which makes sense.

No need to ban it for export. It is 60 years old and every country in the world already has it. It is "cheap as chips". Hence why it is such a great breakthrough. Most countries can now start to use it straight away

No it’s not that we wouldn’t be allowed to use it but when it’s not known what may help a clinical trial rather than gut instinct is the best and most scientifically valid way to answer a question .

It's very exciting news. Kid they're still trialling other (known) drugs

As a diabetic it's a bit disappointing it increases blood glucose, which may mean it's not good to be used on us - more testing, more drilling down in the trial details.

But the most exciting thing is they now know treatment can work - a guy whose name I didn't get, was on BBC news later on and he was like a kid in a toy shop, about how brilliant knowing that was!!

@IncrediblySadToo wouldn’t matter about your diabetes - on an ITU they’d have control of your blood sugar

@TabbyMumz

I'm wondering if this is why we have such a high death rate, because medics cant use drugs at their disposal because they could only use it on patients accepted onto the trial, specifically for use in covid. Whereas other countries,they arent restricted so much. As someone up thread said, their vet husband said that would be the first drug they went for? Have medics in the uK wanted to use it, but not been allowed?

I can’t comment on this specific example, but the UK’s coronavirus response in general has been hampered and delayed by a need for strong evidence at every turn. If the evidence wasn’t strongly there or was inconclusive, decisions simply weren’t made, eg on recommending face masks, imposing quarantines, efficacy of social distancing. SAGE’s meetings are full of this kind of slow caution from January to early March. Jenny Harries said on 10th March that there wasn’t enough ‘evidence’ to suggest that mass gatherings were risky and they should go ahead to prevent disruption to people’s lives.

Except that it’s a pandemic, where speed is absolutely of the essence, and where we don’t have the privilege and time to conduct Randomized Control Trials before making every decision.

But like I said, the recommendations of certain drugs for mass use is probably a different ball game altogether.

Hmmm steroid used to successfully treat an inflammatory condition is hardly groundbreaking. I'd be bloody annoyed if I'd been really sick and not given a trial of steroids.

Good news a small step to trying to defeat this , let's hope more good news to come

For those saying why wasn't it just given , the virus was unknown they can't just chuck anything at patients what if it made it worse ? Other countries have tried various other drugs too as have I'm sure there have been various trials etc and we will likely continue to look at other options and ways to defeat this virus . We are all still learning but as time goes on we hopefully will get more answers from all over the world as countries all start looking more into what can possibly work etc

This has made me feel more positive

I'm glad there's something & cheap... but there would still be 37k people dead. Lots of people it could not save. This is not the path out of coronavirus crisis.

I like evidence based medicine. It means my taxes get spent on things that work. It's how we find things that work rather than hike up the profits of random drug companies that got Sleb endorsements.

⭐🙏⭐

:TabbyMumzWhy would medics have been prescribing a drug with no evidence of efficacy?"
They have been using this drug for 60 years. It's been working for 60 years on people with breathing difficulties and inflammation. I just dont get why they need a trial now!? When any patient walks through the door of a hospital with a condition, I would have thought medics would have a whole raft of drugs to try and this be one of them. Weve been told theyve given patients in ICU blood thinners, surely they didnt have to do a trial on them for covid patients? This is what I dont get. Have doctors been able to use this drug from the beginning, or have they been banned because there is a trial?

I would have thought medics would have a whole raft of drugs to try and this be one of them

But if you go for a scattergun, suck it and see approach, without collecting evidence to see whether you're helping or hindering, it's impossible to make progress and develop the best protocol. A French doctor was/is insistent that hydroxychloroquine helped his patients survive. But research doesn't back that up.

Great news.

"But if you go for a scattergun, suck it and see approach, without collecting evidence to see whether you're helping or hindering, it's impossible to make progress and develop the best protocol. A French doctor was/is insistent that hydroxychloroquine helped his patients survive. But research doesn't back that up."

Yes but on the flip side to that, have they just been putting them on oxygen and nothing else? Surely not? Surely doctors have been allowed to try this drug? That's what I'm trying to understand. Have they been allowed to try it up to now or not? Have doctors been thinking "this patient needs a steroid, so the best one would be this drug" but then not allowed to use it because it's part of a trial?

Randomized trials like RECOVERY are not allowed if there is already clear evidence that a particular treatment, such as dexamethasone, will benefit patients. When covid-19 emerged there were concerns that corticosteroids, like dexamethasone, might actually cause harm due to experience with SARS and MERS. It was therefore actually advised that patients were not given these kinds of drugs outside of a clinical trial so that it could be determined whether it was safe and effective. Don't forget that whilst there was a theoretical benefit - steroids reduce inflammation, there was also a theoretical risk - inflammation is part of the immune response to a virus and suppressing it could let the virus cause more damage.

Giving patients drugs that have not been shown to work for their condition outside of a clinical trial is risky. You might think that it's a risk worth taking, but in practice that will mean more people die overall. Either because they end up being treated with a drug that actually causes harm - like hydroxychloroquine - or because we don't find out that a drug that was thought could be dangerous, is actually beneficial - like dex.

@TabbyMumz Yes, there's this trial of a new drug. They are only recruiting 60 participants so it looks fairly early days and it's not licenced as a treatment for anything else yet. Not sure if any already licensed drugs are being tested.

That's brilliant, thanks CountFosco..