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Dexamethasone RecoveryTrial data out
Not yet peer-reviewed but thank goodness for preprint
A few reflections
1. The randomization worked. The groups were pretty balanced
2. They pre-specified their subgroups. That& #39;s important
So the results?
Thread
https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1.full.pdf">https://www.medrxiv.org/content/1...
Not yet peer-reviewed but thank goodness for preprint
A few reflections
1. The randomization worked. The groups were pretty balanced
2. They pre-specified their subgroups. That& #39;s important
So the results?
Thread
https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1.full.pdf">https://www.medrxiv.org/content/1...
1. Large over-all benefit. Absolute mortality 3% lower for Dexamethasone
2. Subgroups. Now it gets interesting! Tells us a lot about COVID19:
--No 02 support: Mortality looks higher for Dex
--02 only: Mortality 3.5% lower for Dex
--Ventilator: Mortality 11.7% lower for Dex!!
2. Subgroups. Now it gets interesting! Tells us a lot about COVID19:
--No 02 support: Mortality looks higher for Dex
--02 only: Mortality 3.5% lower for Dex
--Ventilator: Mortality 11.7% lower for Dex!!
The benefit in 02 only and particularly for ventilated patients are very large
I can& #39;t find much wrong with approach or analysis but will see if others do
But this study hints at a bigger point about this disease
I can& #39;t find much wrong with approach or analysis but will see if others do
But this study hints at a bigger point about this disease
. @jeremyfaust and others have raised the question -- why is this different? There was no similar benefit for SARS or MERS. Why for COVID?
Key line from paper:
Beneficial effect...is dependent on using the right dose, at the right time, in the right patient
4/5
Key line from paper:
Beneficial effect...is dependent on using the right dose, at the right time, in the right patient
4/5
Early in disease course: key is controlling virus and steroids likely harmful
Later in disease course: Immune response may be the problem and drugs like Dexamethasone helpful
That means that if you take the drug too early, it may end up doing more harm than good
5/6
Later in disease course: Immune response may be the problem and drugs like Dexamethasone helpful
That means that if you take the drug too early, it may end up doing more harm than good
5/6
Finally:
This is great. A fabulous study done under the most difficult of circumstances by @UniofOxford researchers within @NHSuk
Huge bow to the Recovery Trial investigators
This is great. A fabulous study done under the most difficult of circumstances by @UniofOxford researchers within @NHSuk
Huge bow to the Recovery Trial investigators
