Discover and read the best of Twitter Threads about #dexamethasone

Most recents (12)

A thread.
I was alerted to a Newsweek paper by Yale professor of Epidemiology Harvey Risch in which he argues quite persuasively that #Hydroxychloroquin, #HCQ (= Azithromycin + Zinc) is an effective treatment for early-stage #Covid19 and has been opposed on spurious grounds
Here's a link to the Newsweek article. It refers to a paper by Risch in the Americal Journal of Epidemiology (#AJE) which details the evidence. newsweek.com/key-defeating-…
I looked at the #AJE paper. The abstract is here as a screen shot. It is freely downloadable as a pdf and there is a supplemental 'doc file with the details of 5 studies. Image
Read 21 tweets
1/
#SARSCoV2 #COVID19 got you down? Me too.

Ready for some good news? Here it is: #Dexamethasone (dex) works.

But when, how much, and for which patients?

Here’s #HowIReadThisPaper on Horby et al: the RECOVERY trial prelim report: nejm.org/doi/full/10.10…

(Thread)
2/
Already read the paper, just want the appraisal? Go here:

Haven’t read it yet? Here are the highlights.

Based on my very informal poll, here’s how twitter respondents indicated they are using dex in COVID19 patients as of mid-July 2020:
3/
Background: COVID19 can induce a deadly hyper-inflammatory host response.

Prior observational data (↓quality, ↑risk of confounding by indication) suggested ↑mortality from steroids in influenza: pubmed.ncbi.nlm.nih.gov/30798570/

The role of steroids in treating COVID19 is unknown.
Read 17 tweets
The power of large, pragmatic randomized trials. Conducted by academic researchers using an adaptive trial design (#MAMS), and you’ve got a winner. Strong reasons why publicly funded research is so very important. Thread
The #RECOVERY trial has answered 3 important, clinically relevant questions about #COVID_19. It has shown that #Dexamethasone is beneficial in patients requiring oxygen/ ventilation & that HCQ and Lopinavir-Ritonavir are not useful.
#HCQ results are now out in preprint!
#RECOVERY randomized 1561 pts to #HCQ and 3155 to standard of care. Primary endpoint of 28-day mortality was 26.8% in the HCQ arm and 25% in the SOC arm. Lack of benefit consistent across all sub-groups. And remember, 28-day mortality in the same trial in the Dexa arm was 21.6%
Read 6 tweets
🔥On demande fréquemment où on en est pour la prise en charge #COVID__19 #COVID19 #SARSCoV2

Pas de traitement spécifique spectaculaire mais importance majeure des soins standards de pneumopathie virale sévère

Voilà une humble mise au point à destination grand public.

👇1/n
2/ On sait maintenant que >95% des cas évoluent favorablement sans traitement
Pr ces formes bénignes importance ttt symptomatique + surveillance notamment si à risque d'aggravation (âge avancé, ATCD médicaux : diabète, obésité, etc.) + information précise

antibioclic.com/questionnaire/…
3/ Pour formes sévères nécessitant hospitalisation, le + important reste le standard de soins d'une pneumonie virale sévère à savoir oxygénothérapie / support ventilatoire à adapter à chaque patient, prévention complications, kiné respi, gestions des atteintes d'organes 2ndaires
Read 15 tweets
"Tomorrow marks six months since WHO received the first reports of a cluster of cases of pneumonia of unknown cause in #China.

The six-month anniversary of the outbreak coincides with reaching 10 million #COVID19 cases and 500 thousand deaths"-@DrTedros
"This is a moment for all of us to reflect on the progress we have made and the lessons we have learned, and to recommit ourselves to doing everything we can to save lives"-@DrTedros #COVID19
Read 32 tweets
Updated the #RECOVERYtrial topline results summary table of the #dexamethasone arm compared to usual care for treatment of hospitalized patients with #COVID19.

Got additional information colleagues shared in Twitter.

Thread with some comparisons with #ACTT1

#IDtwitter 1/
the #ACTT1 authors have only reported (preliminary) Day 14 mortality, and the #RECOVERYtrial has only posted Day 28 mortality.

But these days the Supplementary Appendices in trial reports have additional relevant information:
nejm.org/doi/full/10.10…

#DontCoverDiscover
The paper says they were not reporting day 29 mortality, but If you look at Figure S3 in the #NEJM #ACTT1 preliminary report, you have KM estimates out to day 30.

From there you can visualize the probability of death at day

28 (see figure) have left lines and scales
Read 12 tweets
The drug #dexamethasone is a steroid. Now the word "steroid" evokes all manner of reactions, but in essence medics use "steroids" mainly in exchange for a specific subgroup of the huge class of hormones and their analogues, namely the #glucocorticoid group.
All steroid hormones are produced in the body from cholesterol (don't worry statin users, there's plenty for everyone). They are converted by enzymes in various organs to specific hormones that are released and controlled by all manner of systems. (O)estrogen, progesterone...
... testosterone, cortisol and aldosterone are the main members. Each of these has intracellular receptors in their target tissues. They are fat-soluble and most of them need a carrier protein in the bloodstream to actually circulate around the body (e.g. SHBG, sex hormone...
Read 14 tweets
Tabulated the topline results released by the #recoverytrial team on #hydroxychloroquine & #dexamethasone, and went over their protocol (recoverytrial.net/results) to better digest them.

Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Important point from #RECOVERYTrial protocol

- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
So if a patient enrolled in #recoverytrial had a contraindication to #dexamethasone, that patient was not allowed to be randomized to that arm. So the results need to be interpreted in the context of no contraindication to steroids: already on steroids, #immunosuppression, etc.
Read 11 tweets
1/ The time has come for yet another #debunking, this time of sheer hype re a medication used in treatment of severe or critical #COVID19. #Dexamethasone is a bog-standard form of cortisone, & only useful to reduce inflammation.
2/n It's nice of the report to include an extrapolation of how many lives would be saved if you use #dexamethasone in the treatment of certain cases of severe to critical #COVID19, but as you can see from the figure, it actually isn't all that much.
bbc.com/news/health-53…
3/n #Dexamethasone is being *deliberately* hyped up. Not for financial reasons. It's a bog-standard form of cortisone, *nobody* is going to get rich from making a financial killing in it.
Read 23 tweets
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.
apnews.com/89d963958b042c…
"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.
bbc.com/news/health-53…
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."
Read 15 tweets
148/x
Wearing a mask can help mitigate the super spreading phenomena:
149/x
We should also be on the lookout for asymptomatic cases, as they can significantly contribute in adding to infections, should they go unchecked; We need more testing in general, as well as of asymptomatics:
Read 167 tweets
1/ Little Thread about all The Misleading Medical Information still floating around about #Hydroxychloroquine & #Chloroquine & #Azithromycin & #ZelenkoProtocol - by 1 doctor - @zev_dr & #Remdesivir & more

Despite #TrumpIsNotADoctor has stopped saying "What do you have to lose?".
2/ #TrumpIsTheWORSTPresidentEVER

First, why it has been political all the way, suspected from day one:

"Trump had been touting HCQ for weeks, sparking worldwide shortages of HCQ & prompting negotiations with Indian PM Modi to lift export restrictions"

vanityfair.com/news/2020/04/i…
3/ #Trump2020

Indian PM Modi and Trump held a rally together.

"Mr Trump wanted to show people in the US that he was hugely popular abroad and that he was capable of negotiating good deals out of a country he once described as the king of tariffs"

bbc.com/news/world-sou…
Read 42 tweets

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