Note: This thread is related to #Coronavirus #COVID19

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Ashish K. Jha+ Your Authors @ashishkjha Physician, researcher, and advocate for the notion that an ounce of data is worth a thousand pounds of opinion. Director @harvardgh. Soon, Dean @Brown_SPH Jun. 23, 2020 1 min read + Your Authors

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Not yet peer-reviewed but thank goodness for preprint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's important

So the results?


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!!

The benefit in 02 only and particularly for ventilated patients are very large

I can'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 dependent on using the right dose, at the right time, in the right patient


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



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

One more thing

Because we can't edit in twitter, a minor clarification.

The groups in this trial are pretty balanced.

But even if they weren't -- doesn't mean that randomization was flawed.

You can follow @ashishkjha.


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