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Woke up to Twitter going wild about #dexamethasone treatment for #SARSCoV2 #COVID19 #coronavirus infection.
Went to look at the paper. Still looking...uh oh, this looks like another case of trial results by press release, a very unfortunate trend. https://apnews.com/89d963958b042cc921e64ab3eff5a74d
Went to look at the paper. Still looking...uh oh, this looks like another case of trial results by press release, a very unfortunate trend. https://apnews.com/89d963958b042cc921e64ab3eff5a74d
"Results were announced Tuesday and researchers said they would publish them soon."
Okay, great. How soon is "soon"? Because according to this @BBCNews article, this should immediately be used as treatment for severely ill #COVID19 patients. https://www.bbc.com/news/health-53061281
Okay, great. How soon is "soon"? Because according to this @BBCNews article, this should immediately be used as treatment for severely ill #COVID19 patients. https://www.bbc.com/news/health-53061281
Press reports say this trial found it significantly reduced risk of death for patients requiring oxygen or on ventilators. Per PI Peter Horby: "This is the only drug so far that has been shown to reduce mortality - and it reduces it significantly. It's a major breakthrough."
Study lead Dr. Martin Landray says, "There is a clear, clear benefit. The treatment is up to 10 days of dexamethasone and it costs about £5 per patient. So essentially it costs £35 to save a life. This is a drug that is globally available."
This is all great if true. And sure, it PROBABLY is true. But how can anyone know if these claims hold up when the only data available for scrutiny by the larger scientific community is from a press release? Here's the thing about press releases: they usually are kind of biased.
The purpose of a scientific paper is to report data in an open way so the rest of the scientific community can reproduce the work and assess the robustness of the findings and methods. The purpose of a press release is to basically brag about your awesome study.
Even worse, this is a clinical study. This isn't just like "cool finding, great insights, gold star", this is "let's start treating severely ill patients with a potent immunosuppressive drug." Dexamethasone is a corticosteroid that profoundly suppresses inflammation.
It's reasonable to think that dexamethasone would work to treat patients with a "cytokine storm" that causes the severe inflammation associated with severe #COVID19. It sounds like that's what the study shows. But we can't see the data for ourselves because it's not public.
Furthermore, this can be very misleading to the public. People read stuff like "The first drug proven to cut deaths from Covid-19 is not some new, expensive medicine but an old, cheap-as-chips steroid" in the @BBCNews piece and think "great, dexamethasone for everyone"
Except dexamethasone, because it is such a potent anti-inflammatory, might be harmful if given to patients too early or with mild disease. Inflammation is critical for mounting an effective antiviral immune response. Steroids too early in infection could hinder virus clearance.
A lot of people think all inflammation is bad, but it's an essential component of the host response to infection. Inflammation itself is important--it's when that inflammation gets out of control that it is harmful, as in patients with severe #COVID19.
Therefore not everyone should be taking a "cheap-as-chips" steroid. But many who read the available information will see "life-saving" and "cheap old drug" and not absorb the caveats. Maybe if it works for the most sick it can work for me? Maybe I can take it to prevent COVID?
Taking dexamethasone won't prevent #SARSCoV2 infection or treat mild #COVID19 and could actually make it worse by suppressing antiviral immunity. It's not great to take corticosteroids long term. So please don't call up your doctor demanding a prescription for dexamethasone.
We desperately need effective drugs for treating #COVID19 so I understand the need to get the information out ASAP. I hope that the dexamethasone trial holds up to close scrutiny once the data is released in full. This is potentially a REALLY important result.
But I urge scientists and physicians--especially those working on studies with implications for clinical practice--to PLEASE not disclose results by press release with no accompanying data. Evidence-based medicine requires evidence. It's not optional.
