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  • By - ngt_

bostonian277

"Lead researcher Prof Martin Landray says the findings suggest that for every eight patients treated on ventilators, you could save one life. For those patients treated with oxygen, you save one life for approximately every 20-25 treated with the drug. "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."" Wonderful to hear that they've found an impactful, cheap, and readily available drug to help in all this.


butwhatisthequestion

Wait until the US starts to implement it. Cheap will be the first word dropped from the headlines.


DistanceMachine

And available.


BookSandwich

And pandemic.


[deleted]

They'll replace it with endemic since it might only be in the US at that point.


Rhuarcof9valleyssept

As an American I am bracing for this day. Gross incompetence at all levels over here.


xXTwelveGageXx

In other news Missouri is entering phase 2 of re-opening: no restrictions! Pandemics are so easy they can be solved with a simple two step process.


jy-l

Step one: don't test Step two: don't tell


DatSkrillex

Step Three: profit


DeveloperForHire

South Carolina is fully open. The only restrictions we had were close-contact businesses like hair salons and bars had to close for the month of April. It's June, and the numbers haven't stopped rising.


rathlord

That’s not very accurate. Per the governor’s stay home order, only non-essential businesses could stay open and citizens were required to stay home, at work if their work was considered essential (it was a fairly broad list, but it’s the same as most states and identical to NC), or with family. Restaurants could not serve anything other than to-go and any business not on the list was closed, not just the ‘salons, bars, and gyms’ that were the first to close and last to open. E: yes, I know people didn’t really follow the order, same as anywhere else in the US.


dabsaregreat527

I live in Charleston and can confidently say the stay at home order was not inforce or thought about for a lot of people here. I saw Snapchat and Instagram posts of people at bars all the time. Even now every third person still refuses to wear a mask and all the buissness have been open I'm some way. Even for sit down dining in when it was supposed to be take out only


Agravicvoid

Ohio went from leader of common sense to “ok let’s just reopen everything because a small group protested the shut down” Thankfully my church seems to be the most level headed and has not reopened for in house services and is sticking to online only with the option for small groups, and even most of those are still opting for online. Those churches that complained that “we need to be in church now more than ever” clearly never actually studied the Bible. I like to say “God gave us a brain and I know he’d like us to use them”


Delilahtherebelangel

I live in a super fundamentalist Christian community and they've cancelled in house services indefinitely. This a very devout community. Im completely shocked by it honestly. But im glad to know they are following guidelines and protecting their congregation which is honestly mostly a high risk crowd.


Insidevoiceplease

I'm a Missourian; my county has been open since **April**. People barely even seem to wear masks. Its pretty gross.


GoochMasterFlash

I live in a closed county but have been working in an open county, and youre right it truly is night and day. In my county everything is closed except whats necessary and almost everyone wears masks. Anything that is open requires a mask. In the county Im working in due to the restrictions no one is wearing masks, except people being required to wear them for work. But businesses arent even requiring that in a lot of places, including mine. So I literally go to work wearing a mask, to work with people not wearing masks, and be around patrons who never wear masks while there. The worst thing about this is that all the people coming to our facility live in my home county and mostly in my area. So these are people actively choosing not to wear masks even though they definitely have them, because they need to in order to go to the store where they live.


welchplug

welcome to the machine


Mr_Incredible_PhD

Welcome, my son.


[deleted]

Where have you been, it’s all right we know where you’ve been


Shoelesshobos

You've been in the pipeline filling in time.


Lance_Henry1

Which definitely RATM wasn't raging against. They were against dishwashers all along...


user__3

As a former dishwasher of a senior living community, I already had enough people raging at me


Conquestofbaguettes

Canada needs to build a wall. And make America pay for it.


Rhuarcof9valleyssept

That's probably a good idea. Edit: guys this was a joke.


helldeskmonkey

Just tell Trump there are dark-skinned foreigners in Canada. He'll demand a wall is built, tell everyone that it will be paid for by Canada, then stiff the contractor and claim victory.


fables_of_faubus

And Brazil. But they'll have stopped testing completely by then.


[deleted]

Trump will simply repeat his PPE grift. He'll use federal authority to confiscate all shipments to create a shortage that drives up the price, then he'll hand out manufacturing contracts to his buddies purchasing at this higher price, and they will then delay fulfilling the contracts until the price goes down, at which time they can simply order from another company to be delivered when we don't need it.


aromachief

Dex is an extremely commonly used substance. Even if we used it for each and every COVID patient, its use would far be outstripped by people being given it for allergic reactions, hives, IV sedation, vomiting, asthma exacerbations, injuries...


ToxDoc

I’m puzzled. People are talking like this is some investigational drug. Plenty of us have been using it for COVID.


Neuchacho

The application specific to COVID is what was investigatory. We've known steroids help with lung diseases, but we didn't have a quantified amount, in regards to specific steroids, of how much it helped with COVID. Now we do.


Dude-e

Fortunately, the drug is already used for a very wide array of medical issues. It’s available in most, if not all, hospitals. I hope they don’t find a way to overcharge on something that’s been available for decades


douko

>I hope they don’t find a way to overcharge on something that’s been available for decades Hahaha Oh wait, you were serious #HAHAHAHAHAHAHAHAHAHA


koreiryuu

I was charged $55 per 200mg Tylenol, I'd say all bets are off.


c-digs

£35 GBP = $44.24 USD We all know that American lives are worth at least 100x more than the lives of any other nationals. So 4,424.00 it is. On second thought, let's just round that up and call it $44,240.00. An American life has to be worth that much, right? -- [Mick Kolassa](https://www.chicagotribune.com/business/ct-mick-kolassa-drug-pricing-model-20160503-story.html) ^probably


MajesticMetaphor

That’s exactly how much my gf chemo treatment costs that she must have every two weeks or risk a relapse with her blood disorder. And when she lost her job and insurance at the beginning of all of this, she couldn’t get the treatment for 3 months. There wasn’t a shred of compassion for her. Come to find out, this drug was 99% funded by taxpayers and here she is having to fight for her life for it. It is absolutely absurd.


ttthrowaway987

T-cell acute lymphoblastic lymphoma? Or leukemia?


MajesticMetaphor

Atypical hemolytic uremic syndrome.


ttthrowaway987

Oh man, that is rare! Less than 1000 cases/yr in the US. It sucks to be sick but at least it was diagnosed. Hope it works out for the g/f! And health insurance in the US sucks!!


MajesticMetaphor

Rare in this case means it cost more for you to live! Probably have a better shot at hitting the lottery and at this point we need that! Thanks for the concern.


Craico13

> A life is simply worth so much money that the government can’t afford to save it. > ^Unless ^it’s ^unborn. - Republicans/Conservatives


[deleted]

Spicy. I like it.


cpc_niklaos

You don't get it, unborn life can't fight for itself so you got to protect it. As soon as it's born though it can and needs to fight for itself. Otherwise, that life is lazy and therefore deserves to die. Edit: Apparently it needs to be said, that's sarcasm guys.


DontDoItTuna

Sadly, I can’t always identify sarcasm on the internet anymore.


300Savage

There's a reason for that. A lot of stupidity looks at first glance as though it may be sarcasm.


Churosuwatadade

> So 4,424.00 it is. Most people have annual copays larger than this.


c-digs

Damn, you're right. This price is totally unrealistically low.


Heflar

a life is worth a lot more than 44 usd, so i expect them to mark it up to about 2000 usd per persons treatment.


itsyourmomcalling

You cant put a price on a person's life. But in this case its $2000 for the drug, $480 for the nurses time, $978.53 per day for the hospital bed, $150 for the needle, and then $3,500 for the tests to make sure you cured.


galendiettinger

$978 per day for the hospital? What are you looking up, $1950s prices? A coworker of mine recently spent 2 weeks in the hospital with COVID and received a $250,000 bill.


massare

Holy F***! What if you're broke? Can you ~~just die~~ wait in your home or are you forced to go to the hospital?


galendiettinger

If you're broke you can still go to the hospital and they have to treat you. They're going to give you a ridiculous bill when you leave. At that point, you can try to prove you're broke and they'll reduce it, or declare bankruptcy to remove the debt. Fun fact: medical bills are the single most common cause of personal bankruptcies in the US.


pawnografik

Sorry to tell you this mate. But from the outside it looks a lot like your society is fundamentally broken.


galendiettinger

Everybody knows. But politicians need campaign funding, so...


sold_snek

You can get treated. ​ You'll just never be able to buy a home.


itsyourmomcalling

And if you already have one. Just sell it.


ForeignNecessary187

Then sell your family.


hightio

Accurate until the 988 per day in a hospital part. That's closer to 5,000.


TimsKillerRabbit

That is actually fucking insane. No wonder the US is so utterly backwards when it comes to healthcare.... like one of those shithole countries Trump previously referred to. ​ What grinds my gears whenever "universal healthcare" is discussed in the US, "how are we going to pay for it!?!?" is always the response.... ​ Well..... look at how it's been implemented ACROSS THE WORLD. You're not paying for it now. If people think Americans are paying their medical bills off in full then they're living in fucking cuckoo land.


itsyourmomcalling

And just think. If the US took 200 billion from their defense spending and put it into their health care their defense budget would still be almost 2 times that of their next closest 2-3 competitor.


WaffleBlues

Now, now, it only goes up to 5000/day if you require the use of a blanket (500.00/day), food (75/meal) use of a restroom facility and garbage can. Also, the parking lot fees and elevator fees.


Lovat69

Don't forget the $3000 air fee.


hightio

My kid went to the ER one day and they offered us Tylenol. He didn't want to take it so they left it on the table. We ultimately left without him taking it. Not only did they charge us over $50 for 2 Tylenol in a cup, they charged an $18 "self administration fee".


Lovat69

:/ When satire becomes reality.


Hakion

What the actual fuck America!


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UnusualMacaroon

Technically speaking, the official numbers are set by the State.


mysixthredditaccount

I know you are not going in that direction, but your comment reminded me of an article I read recently that was talking about how life is valued (in dollars). And American life is generally on the expensive side (around 10 million USD per person if I remember right). Even though it sounds inhumane to value life in money, it's a part of our everyday reality even when we don't notice it. For example, if I offer you a million dollars to take an action that has a documented and undeniable 0.1% chance of killing you, would you take it? If yes, then you value your life at less than a billion dollars. There are Americans out there working very dangerous jobs (statistically), for a few thousand dollars a month. Its worse in third world countries where they heavily risk their lives for a few hundred dollars. Also, when it comes to making decisions for the public, putting a dollar value on life plays a very big role. Should the government spend 100 billion dollars on a search and rescue mission? How about 100 thousand dollars? If resources were infinite, then this wouldn't be a need for this question, and the government could just spend a trillion dollars on saving every single life that could be saved. But since that's not the case, the line needs to be drawn somewhere, and knowing how much a life is worth plays an important role in that.


c-digs

I'm a realist and a pragmatist so I don't disagree in principle *if there is a constraint*. Often, that constraint is some resource be it research capacity, real goods like ventilators or hospital capacity, etc.. But when we're talking about things like insulin -- motherfucking insulin -- then that logic breaks down. There is no reason that insulin shouldn't be practically at cost at this point. The only reason is greed.


Brittainicus

Its a consumable good that's needed to live and its super cheap to make. Its really closer to a special kind of food you need to consume than expensive search and rescue or just expensive/fancy machines for medical care that may cost at lot for a one off thing.


c-digs

That's exactly my point; perhaps you're not familiar with how absurd it is to acquire insulin in the US. [States actually had to place price controls in place at the onset of the pandemic](https://www.everydayhealth.com/type-1-diabetes/new-mexico-becomes-third-us-state-to-pass-insulin-pricing-cap/). > Earlier this month, Virginia and New York passed similar laws aimed at commercial insurance coverage. The New York measure, which limits copay costs to $100 per 30-day supply *$100 is the **copay** for a 30 day supply*


istasber

It's not just the government, but private insurers use a similar measure. In all cases, it's usually presented as the value of a productive human year. If a disease makes you miss work on average a month per year, the value of treating it should be 1/12 of a year, that sort of thing. How those measures are evaluated is also different in different countries. IIRC, the US tends to favor treatments that have a greater acute effect even when the long term prognosis is worse than the alternatives. The cynical view is that this is because private insurers are looking to spend as little as possible to get someone to 65, at which point they become the state's cost. Spending more to treating someone at 45 to improve their health at 65 is a losing proposition for the insurers, so they don't do it.


ColoneISanders

$444,240.00 you say? Well that's the best $4,442,400 I've ever spent!


Unzbuzzled

Dexamethasone is already on formulary everywhere in the US. It’s just a systemic corticosteroid, and it’s already in use for a myriad of inflammatory diseases.


life_is_g00d

I administer drugs in the operating room in the US. This drug is used on almost all patients. It is VERY available and VERY cheap.


ToxDoc

Uh guys? Dexamethasone is widely available. Am US ER doctor. I used it in lots of COVID patients, although most of my colleagues used methylprednisolone. While there are differences in the two steroids, I doubt one will have that much more utility of the other This is more of confirmation of what many thought.


Bilikeme

What is the back up option for someone who is allergic? For instance: I found out a few years ago I’m allergic to prednisone when given it for a workman’s comp injury. I’ve taken it when I was younger and no issues and now issues. Earlier this year, had a back injury at work and told the PA I’m allergic to prednisone can’t take it. So he prescribes Dexamethasone and says if you feel itchy or anything take some Benadryl and go to er. I take a tab and 10 mins later feel a little itchy. Don’t think much of it I take a Benadryl anyways. Go to bed around 9 pm and by 11 I wake up and have no control of my left arm. Go to er and luckily I wasn’t having a stroke but kept be for a bit and said to stay away from all steroids now.


ToxDoc

An true allergy to steroid is very rare. I’d wonder if the allergy is to an excipient. Seems like an allergist and testing would be the best idea.


Jtk317

We have been using dexamethasone for inflammatory conditions (sepsis, encephalitis, ARDS, etc) for years. This is not new. The big issue was that in the early parts of the pandemic, people receiving steroids were showing worsening of immune response, which is not uncommon, and still needs to be factored into timing of steroid treatment.


daOyster

It doesn't work like that. That's for drugs that are new and freshly patented, not ones that already have quite a few generic formulations around like this dex. Big pharma can raise the price all they want, one of the generic companies can then just completely undercut them and drive them out. Welcome to one of the good things about capitalism and health care.


The_Wizard_of_Bwamp

The world: "Hey we found a cheap and effective treatment that everyone can afford! This could save lives!" The United States: (Hold my beer) "We're going to make so much money off this inflated price because life doesn't matter. Money is god and I need to get reelected."


Vommymommy

we’ve already been using it on all our covid patients. ever since we figured out the immune response was what was killing some people. i love how this makes it sound new 😂


CheeshireCat

The drug isn't new. But surely the evidence is new and that's a very different thing.


flickh

Saving 1/8 is nice but I wouldn’t go around licking doorknobs just yet


informedinformer

Amazing how far down I had to scroll to find someone pointing out how few lives are saved by this drug. It's nice to know it saves some lives, but it sure as hell isn't *the* panacea for this pandemic.


GuineveresGrace

THE ANSWER HAS BEEN DEX THE WHOLE TIME?! *stares at veterinary emergency kit in car*


Bonushand

In medicine, the answer is always dex. Seriously we use it for every disease. Or we've tried it for every disease and then found out it doesn't work for some of them. In neurology we say "no one should die without a course of steroids" whenever we see some weird progressive brain disease.


GuineveresGrace

Honestly I don’t know much about human medicine; all my experience is in small animal emergency and large animal. I love seeing the cross overs though.


WaywardTraveller

FYI: This is a bullshit clickbait interpretation. This drug is not new or novel, and this is not a new or novel use of the drug. It's been used extensively to treat these symptoms from COVID since day one.


aguafiestas

It's a clickbait title, but this is still a big deal. People have been throwing a lot of different treatments at COVID and this is the first shown to reduce mortality. People have been throwing dexamethasone at a lot of critical illnesses over the years, sometimes it works but often it doesn't.


GuineveresGrace

Honestly I’ve not been paying attention to alternative-use (not to be confused with ‘alternative’, ie homeopathic) drugs. Kinda assumed they’re gonna have to spend a lot more time coming up with a reliable, reviewed treatment plan instead of ‘throw water at the fire, and hope it works.’ Just surprising to see a drug mentioned when I have three vials in my truck’s cool box.


WaywardTraveller

Well, that's just it, it's not really alternative-use. It's one of a number of drugs used for similar symptoms related to lung inflammation. It would not make sense for nobody to be trying these kinds of drugs at all. We've got it around the house always as well, wife's had it prescribed for years due to her asthma and propensity to develop pneumonia.


tinlizzie67

My first thought as well.


trollfucker69

“So essentially it costs £35 to save a life” translated into American English: “It will cost $750-2k with insurance to save a life. Without insurance it will cost $13k. I’m sorry, that’s just because you pay for the *quality* of the healthcare in America. It’s expensive because we have *the best healthcare system in the whole world!*”


codawPS3aa

American has the 37th best healthcare system https://www.researchgate.net/publication/40869979_Ranking_37th-Measuring_the_Performance_the_US_Health_Care_System


trollfucker69

I never said America doesn’t have really good healthcare, but if we’re supposed to pay an arm and a leg for it, shouldn’t it be the best in the world? If it isn’t, then why should we pay for it as if it is


codawPS3aa

We need to help Corporate greed, and make the health insurance and for-profit hospital CEOs happy, while hourly workers and salaried doctors workers work for him to make him/her rich. 🥾👅♥️


trollfucker69

Eh, I wouldn’t blame the doctors for this. For sure some are greedy and only do it for a fat paycheck, but my family has several doctors and for them it’s about making people feel better. They love what they do and they feel bad charging people as much as they do


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radishkiller

2.4 million USD at a private hospital you day? That sounds like a deal. WITH the new healthcare plan, Trump will cover 10$ of the medication upfront with only a small interest rate of 5% per day you dont pay him back personally. So you'll owe the hospital 2.4 million and trump 10$ with 5%interest daily! It's a great deal! These are the benefits of privatize health care! The rich board of trustees and executives get significantly richer, while the rich get treatment and the poor people finance their lives just so they can live. Everyone wins.


whatsup4

This is a great advancement but 5-17% effective rate means its not the wonder drug everyone has been praying for but it is much better than nothing.


EelTeamNine

£5 = $25,000USD.


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anthropophagolagnia

if only there was an inspirational candidate who has stayed on message for decades, running on a platform of free healthcare for everyone


ArikBloodworth

I'm all for universal healthcare here in the US, but I watched a video recently that pointed out some interesting hurdles with the concept within the US and while it provided some good food for thought, one of the main takeaways was that universal healthcare would probably work better (or even, at all) if it was done at the state level, instead of the national level. Which makes me wonder, why isn't anyone campaigning for to have universal healthcare for its citizens?


trollfucker69

Idk much about business but I feel like it wouldn’t pass on a local level because any of the states left-wing enough to implement universal healthcare are the same states that have major insurance/hospital corporations’ headquarters in major cities. I feel like the companies would lobby against that hard and threaten to take their business elsewhere


talrich

Vermont tried to go single payer, but couldn't make it work. Regardless, they already have one of the lowest rates of adults lacking insurance (#3 at 4.55% uninsured).


Ipokeyoumuch

I know CO and VT tried but ultimately it didn't go anywhere because money, well and healthcare insurance companies had their hands all over it so it was doomed to fail, so they can point and say, see what happens when you try?


Original_Unhappy

Yeah, we knew we were boned the second he dropped out


FerociousFrizzlyBear

I agree with the overall sentiment regarding healthcare costs, but this is a 60 year old out of patent steroid. It will not be expensive.


KubaKuba

It's almost like our elections aren't even representative anymore. Make no mistake, there's a reason shit's burning over here. Our progressive candidate had his nomination stolen the last two primaries. And I do mean stolen. You can actually document the influx of money and media that pushed for Buttigieg and painted Sanders as unelectable in Iowa right before the first primary. From there it was nearly all the American south voting in the same day for their primary, and the money used to push for Biden there is truly staggering. Add all the democratic hopefuls endorsing Biden as their campaigns stalled long after they'd stolen as many delegates from Sanders as they could, adding a particular prior Republican claiming progressive goals to that category. Most of them receive sizable election contributions from private healthcare institutions like Biden and Warren. It's disgusting. Our elections are no longer representative of the peoples' will and I resent the suggestion that it's a result of ignorant voters. It's a result of filthy rich people who are being allowed to use their private funds to affect politics. And our outdated election system. Ranked choice voting would likely hamstring the two corrupt ruling parties in the US.


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Atworkwasalreadytake

I witness things changing. Things are very different from 10 or 20 years ago. Things are much worse.


YoungHeartsAmerica

the affordable care act was much better /s


Kobe9009

Physician here: from my experience in the COVID ICU in a NY hospital we had people on solumedrol (generic name: methylprednisolone) which is another steroid and we had them on pretty high doses. In most cases I didn’t see a huge difference in those that got it and those that didn’t, but some did improve. That being said dexamethasone is a little more potent and I’m sure they used higher doses of dexamethasone than we did for solumedrol and this study had some nice results. Only downside to using the high dose steroids from my experience was having to put almost all our patients on insulin drips because their blood sugars were so damn difficult to control. Would be great to see dexamethasone utilized at my hospital and I’m sure it will be soon after additional ICU attendings review the trial. Edit: Thank you for all the awards, my first ones ever!


Patlani

ER physician here, working with COVID-19 patients in Mexico since early April. We switched from methylprednisolone about a month ago and been using dexamethasone; we haven’t seen any noticeable difference between these two. Some patients did respond well whilst others did not. Right now we’re using both on a case-by-case basis.


Kobe9009

Interesting, for the case by case basis are you finding you’re giving it more to those who come in acutely hypoxic with rapidly increasing oxygen requirements and likely going to require ICU level care? Also does any specific group that’s receiving it seem to be showing more benefit early on?


O_P_S

It’s cool listening to doctors chat nonchalantly about shit I don’t understand


Raeza

Hmmn yes, I concur. Do you concur?


Thatonlyguy988

Lmaoo that’s what I was thinking


purgarus

Hahaha, thanks for saying it for the rest of us.


AzureSkye27

How long do you have pts on methylpred, just while on vent? Long vent time for covid patients, that must be horrible to manage a high dose for so long.


athos45678

If you don’t mind, you should do an ama or something. I’d very interested in what it’s like working in the Mexican ER during the pandemic. Are you in a major city like D.F. ?


SamuraiRafiki

Forget an AMA, we need to get the world's doctirs on one big Slack or Discord channel


dollarwaitingonadime

That exists. It’s called Medscape Connect.


LeighMagnifique

I’m going to keep myself locked at home. I took dexamethasone during radiotherapy and I felt like a fat slug.


legodjames23

I wonder if it's due to dexa having literally no mineralcorticoid effect. Since in septic shock, solumedro/hydrocortisone are the preferred treatment of choice given its partial mineralcorticoid effects


Kobe9009

This is likely the reason especially in these patients we had who were in septic shock because we definitely wanted some mineralocorticoid. It’s also probably why we didn’t try dexa sooner.


OperationMobocracy

Why do steroids like methylprednisolone have such a stark impact on blood sugar regulation? I've known people who have taken it as longer term therapy who complain about excessive weight gain.


Kobe9009

It’s quite involved in many hormonal pathways but the TLDR is that it causes your body to become more insulin resistant so your cells don’t want to take up glucose. So more of it stays in the blood stream and hence you get higher glucose levels. Additionally it also stimulates your body to produce more glucose. There’s more reasons why people gain weight on steroids but that also ties back to the steroids acting as an additional hormonal response leading to fat deposition specifically around the trunk (abdomen). From an evolutionary standpoint our body produces steroids naturally as a stress response to things like starvation, infection and inflammation. We use our knowledge of these pathways when we give patients steroids.


dryadanae

Thank you for sharing your knowledge. Does the body return to baseline once it’s off the steroids?


Kobe9009

Yes but depending how long someone has received steroids they may need to taper their dosage. Which is why you’ll sometimes hear that someone is on a “steroid taper”. This is because the adrenal glands normally produce steroids for your body and when we give steroids to patients the adrenals will take a vacation. If we abruptly stop steroids in someone who’s adrenals have been out of town for awhile (read 2 weeks or so) then we want to slowly introduce the adrenals back into control rather than dropping them in an ice bucket abruptly because the adrenals may not be able to produce the required normal dose of steroids just yet.


dryadanae

Interesting! That makes sense. Is the taper adjusted for how long the adrenals have been away? Like, hey, this set of glands just popped to the next house over for a couple weeks, they’ll be back in a short walk, but this other poor sod’s fucked off to another continent and it’s gonna be a train, plane and automobile before we see them again? Or is it pretty standard that every set of adrenals is just a car ride away?


Kobe9009

The former* is exactly correct. The longer you’re on it and the higher dose required for that period of time equates to a longer gradual taper. Another instance is if people are on a low dose for 10 weeks then we still taper, albeit there’s only so low you can go before you just stop and assume the adrenals will take over. Edit: mistakenly said latter when I meant former lol


dryadanae

Cool information, thank you for the education!


NationalGeographics

I never thought about steroids being liquid stress before. Fascinating stuff.


perdistheword42

As someone with Addison's Disease who has to take dexamethasone forever, I always get nervous thinking about that. This is why people who have to take it for long periods are at higher risk of developing diabetes, right?


Kobe9009

Yes that is true, long term steroids will expose your body to perpetual levels of hyperglycemia and insulin resistance. Your pancreas will try to do its job by cranking out insulin but it can only do so much before it burns out and you get diabetes. One way to prolong the time before getting diabetes is exercise! It’s one of the few insulin INDEPENDENT pathways to transporting glucose into your muscles and naturally lower your blood sugar level!


mr_ji

Not a physician here: Does a ~12% effective rate really qualify as a cure? Obviously it's better than 0, but hardly sounds like a "cure". More importantly, are physicians going to stop trying other things since this has limited but proven success?


Kobe9009

In my own eyes the only thing that qualifies as a cure is 100% effective rate with 0 mortality. So basically nothing ever meets my criteria sadly. However decreasing mortality from 40-28% when you have hundreds of thousands of deaths is a significant improvement (again if this study holds its ground truths). I doubt people will stop other things. I think this will just supplant solumedrol in the hospital until we learn more and we will continue other supportive measures all the same.


jazzybeans

Definitely won't stop trying other things! As you can see from the discussion, lots of ICUs have already been giving steroids to their patients... It's just such a common thing to try for serious medical issues... Like, it's part of the collection of many things they would throw at a patient to try and help. It's good to know the data shows it helps, but no way is it gonna stop them from still using the other assortment of treatments... It likely won't change practice too much, since ICUs probably already thought it helps a bit but not completely.


[deleted]

It's important to understand what it means to say that 1 out of 8 benefited. Let's say half of all people die, and half of all people live (which was the initial death rate quoted for ventilated ICU patients). Of 8 people, 4 will live, and 4 will die before the drug. After the drug, 5 will live, and 3 will die. In other words, you treated 8 people and saved one life. The remaining people would have died anyhow, or lived anyhow. Of course, living doesn't mean that they may not have long-term damage to their body. But for that one person, I guess you could say they're cured. Quite meaningful for them. Physicians are going to combine this with other effective treatments. The standard of care will be dexamethasone and remdesivir if this pans out.


Thyriel81

>Only downside to using the high dose steroids from my experience was having to put almost all our patients on insulin drips because their blood sugars were so damn difficult to control. Would that mean a diabetic with corona couldn't be treated with that drug ?


Kobe9009

Not the case fortunately. We had many people with diabetes on high dose steroids in the ICU. They were basically placed on an insulin drip prophylactically to help get ahead of the high blood sugars. So it’s definitely not a contraindication to it which is great!


Thyriel81

Thanks, that really helped my wife :)


quequotion

Awesome news but, please, please, *please* move this to the beginning of the article: >Prof Landray said, when appropriate, hospital patients should now be given it without delay, but people should not go out and buy it to take at home. >Dexamethasone does not appear to help people with milder symptoms of coronavirus - those who don't need help with their breathing. I guarantee you hoarders are already trying to figure out how to stockpile this drug, which will serve no purpose but to allow people to die when it runs out where it is needed most.


Kobe9009

Very true, steroids have SIGNIFICANT side effects. Please do not try to get your hands on this medication if you do not need it otherwise you will end up needing medical care for another reason other than COVID


Andonyx

I'm about to have total hip replacement to treat avascular necrosis, likely steroid induced from 3 months of Prednisone to treat an autoimmune condition. I'm on nonsteroidal drugs now that manage the autoimmune condition well. But would this type of drug have similar side effects?


Kobe9009

Yes, similar to other steroids this drug can have avascular necrosis of the hip as a side effect, but typically from longer term use than would be used in the case of COVID.


Andonyx

Thanks for the info.


penguin032

Yes, I had leukemia in 2015, and dexamethasone was used as chemotherapy. I got avascular necrosis and have had 2 total hips and 1 left knee. Was also on prednisone at different times and now currently hydrocortisone. Dexamethasone is like the strong version, prednisone middle, and hydrocortisone the least strong but doses can be similar in ratios.


Andonyx

Yikes. I know we're way off topic now, but 1. I hope you're doing better. And 2. Did the new hips work well for you?


penguin032

Yeah for the most part, I'm doing well. The left knee is still pretty stuck in terms of degrees it can bend, but both hips went well!


lewdite

The data hasn’t even been peer reviewed yet but we’re so desperate that any positive top line gets reported. Same thing that happened with Moderna and the actual data ended up being abysmal.


The-vorpal-blade

Not to mention that high dose steroids can be immuno suppressive so attempting to take it prophylactically could even render you less able to fight off the virus. The way this is being used is to attempt to fight off the massive inflammation that people suffering from the disease already have. Taking it ahead of time is in no way going to help you avoid the virus


toastymarbles

It should also be noted this is all based on essentially a press release of their initial findings and observances of the data, not a completed, published and peer reviewed study. That's not to say it doesn't do what the author suggests, just about *anything* that improves the treatment of covid-19 patients or lessens their suffering during medically supervised treatment is worth trying, but it's worth noting this isn't a guarantee and this drug was just one of 6 used in the study, though it looks promising.


VendettaSA

In my country, you need a prescription to get most medicine other than basic stuff. How are people stockpiling prescription medication? Does the US just have extremely lax pharmaceutical laws?


Alar44

No, this was my question too. You can't just go buy this.


DarkShinobi43

This drug HAS been available since the start, and has been used. Although of course, it has not been used consistently and only in the course of RECOVERY has it been studied. Interestingly the dex arm is now closed to adults (with only children able to be started on it now). All those people saying big pharma will hike the price up, it's doubtful it will increase considerbaly as it there is no patent on it, and is a widely made generic. It is used in control of asthma, rheumatoid arthritis, whooping cough, to reduce inflammation in metastatic cancers to help with pain etc. With all steroids, there are certain risks associated (steroid induced hyperglycaemia, faltering growth, immunosuppression etc). As some have said, I hold my breath until the data has been reproduced and backed up (mostly by the REMAP-CAP trial among others). Finally, THIS WILL NOT BE GIVEN TO MILD CASES, as they are not high risk, those with severe symptoms/severe risk of complications or those admitted will be treated. Edit: as correctly pointed out, hyperglycaemia not hypoglycaemia apologies


R_110

The study itself found no benefit of giving Dex to non-ventilated patients anyway


yaworsky

>The study itself found no benefit of giving Dex to non-ventilated patients anyway The article seems to be implying it does with a number needed to treat (NNT) for patients on O2 of 25. That's not a terrible NNT. I couldn't find published results from the actual trial though. This is the best I found. https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf >Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and **by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021)**. There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14).


Jay-Five

Big pharma won’t hike the price up, but supply and demand economics might, as opportunists buy it up in droves for resale with higher markup.


aguafiestas

It certainly could, but it' already such a widely used drug ([over 1 million prescriptions per year in the US](https://clincalc.com/DrugStats/Drugs/Dexamethasone)) that I doubt there will be a huge impact.


ghostoutlaw

This is a headline and a news article. Any link to the actual study?


fussfilter

The link was in the article, third paragraph: [https://www.recoverytrial.net/](https://www.recoverytrial.net/)


fussfilter

I take that back - there's a Results tab on that website though: [https://www.recoverytrial.net/results](https://www.recoverytrial.net/results)


ghostoutlaw

Yea, I got there, I don't see the actual data for the results of the study.


BaldDudePeekskill

It DOES NOT treat coronavirus. It treats one of its symptoms.


[deleted]

Dexamethasone and steroids have been commonly used in ICUs for decades, and they are commonly prescribed for a wide range of conditions ranging from asthma to rheumatoid arthritis to eczema. They are cheap, relatively non-toxic in the short term, and widely understand on how to manage. Big pharma is not going to be able to magically jack up the price of this any more than they can somehow jack up the price of generic aspirin or orange juice. This study is also very different than most other studies in COVID19. First of all, this study is huge: over 6,000 patients. Secondly, it is the gold standard, a randomized controlled trial. Thirdly, if you believe the results, the effect is enormous. It benefits one of eight people. To put this in perspective, cardiac stenting for heart attack benefits around one if thirty people in terms of death. Fourth, it is performed by a very reputable group with excellent data collection (the NHS). The rub is that steroids like dexamethasone are quite controversial in the ICU. It's very misleading to suggest that doctors dropped the ball by not using them in the first place. Steroids like dexamethasone have been extensively studied in the ICU for decades. There are studies showing that they are beneficial; others show they are harmful. There were concerning reports early on suggesting that they were harmful in coronaviruses. It seems like every week, people are swearing that they are the next big thing or absolutely terrible. Use of them seems to be very institution and doctor dependent. Very often, the logic is "Well, nothing else is working, let's try it and see if it works." There is a large study and reasonably well done study (DEXA-ARDS) that suggests that they may indeed be beneficial in patients with the type of lung damage seen in COVID19 that has converted a lot of people to using it in certain circumstances. But that's certainly not universal. We'll have to see the data, but I suspect that this study is going to lead to widespread adoption, and we'll see whether or not it actually works in the real world. But most importantly, don't rush to your doctor and get a prescription for dexamethasone. People who were not hospitalized derived zero benefit from it. Moreover, it's not particularly toxic, but it does have some serious issues. For example, if you take it for too long and then stop cold turkey, your adrenal glands will probably fail and then you die.


[deleted]

I will no doubt start seeing patients with acute adrenal insufficiency in the next few months after this gets out. Everyone gonna be ordering themselves dex from online pharmacies abroad


masterofninja

Devil in the details - it helps one in eight people *who are on a ventilator*. By definition the population group it helps are already very sick. The results summary (note no data!) suggests no help for those who do not need supplementary oxygen.


Stenbuck

Here's the source. Most news sites I've seen have not linked it directly: https://www.recoverytrial.net/news/low-cost-dexamethasone-reduces-death-by-up-to-one-third-in-hospitalised-patients-with-severe-respiratory-complications-of-covid-19 There is no published article at this time (that I could find); just this statement.


KE55

It's disingenuous of the media to be wise in hindsight by highlighting that up to 5,000 lives could have been saved if the drug had been used from day one. This was one of many drugs that might have been beneficial. Perhaps patients should've been given ALL of the drugs and substances that have been touted by the media in the past 3 months. I'm sure the side-effects of the cocktail would've been interesting...


[deleted]

[удалено]


mchljdy

Medical student here, this drug is certainly already in use in ICUs within the US. As others have pointed out, this is just a statement and not actual results. Therefore, we can't look at this as definitive proof (see reaction to hydroxychloroquine). This drug is commonly used to reduce inflammation like that seen with COVID. While dexamethasone is a very useful drug and can help save lives anecdotally, we still need to look for other options that help reduce the cytokine storm of inflammation that causes the respiratory failure.


[deleted]

That's the same exact medication my daughter takes for an aggressive asthma attack. *panics in American* the fucking price is going to skyrocket.


[deleted]

[удалено]


FentPropTrac

REMAP-CAP is being deblinded so we’ll have their data soon too


astrokade

Sounds promising, but I think we should still be concentrating on bringing the light inside the body.


USBombs83

It’s cheap? Great that means it’s gonna be another 3 years before American insurers find a way to mark it up 3,000% and we can have it here.


Jaded_cerebrum

So what you’re telling me is that steroids effective against inflammatory conditions? /s


digitalap3

With SARS and MERS steroids either exacerbated or extended the illness so they were initially avoided. Also with an initial focus on stopping the spread there was/is a concern that steroids increase and extend viral shedding. Once we started using them because nothing else worked patients were still testing positive a full month later.


spudthefish

Super important. At my hospital we have many covid trials running, and very few included steroids for this exact reason.


FentPropTrac

It quickly dawned on us that this wasn’t standard SARS-type ARDS so tried methylpred as a rescue drug. Saw some reasonable responses and had some discharges of patients I was convinced had about 12 hours to live at one point. Have honestly never seen such severe physiological derangement survive before. Remarkable really.


capstonepro

No, that’s why these things need to be studied. “Logic” in biomedical studies is notoriously shit. That’s why things are failing the vast majority of late stage trials. Exhibit A http://www.crash.lshtm.ac.uk


whitesugar1

Oh really? A cheap life-saving drug COULD benefit poor countries? Who knew


bareboneschicken

Per GoodRX, you can get thirty 4mg tablets for as little as $7.49 USD.


mfurlend

1. Everyone has already been using this because it's dead obvious. 2. It will never run out or become expensive because its used for freekin everything


Huskerzfan

How about they research how many lives it will save in the future. Hate to be crass, but hindsight #s here is sorta odd to me.


tastetherainbowmoth

For more realistic headlines go to r/coronavirus wtf is this shit?


roundfishbook

Well, 'poor countries' should have actually said 'healthcare-poor countries', and then include US in that list.


Sweet-Heat29

Can’t wait to spend $10,000 on this in the US if I get sick


JimmyV080

So if it is cheap and can benefit poor countries, it will cost approximately $3,000 per pill in the US, and no insurance company will cover it because too many people will need it. Got it.


lick-her

The title feels a little click bait to me. It is only 20-30% effective for the most critical patients; not universally life saving.


Darkranger23

But, but, Dexamethasone doesn’t sound like Hydroxychloroquine?


talrich

Dexamethasone is a cheap generic in the US. The US has a problem with brand, specialty and biologic drug prices. Most of the US's generic drug prices are quite low, though there are notable exceptions. About $8 retail for #30 at Costco even without insurance. [https://www.goodrx.com/dexamethasone](https://www.goodrx.com/dexamethasone)


JonWicksDawg

American here... can someone explain these big words to me. ...Specially the word “cheap”


CutOfTheMill

The word "cheap" means very inexpensive in most languages. In American English, according to the pharmaceutical world, "cheap" means best of the best, typically leading to astronomical price gouging on common society.


intergalactic_spork

Oh, I thought "cheap drugs" meant those toxic knock-off drugs only sold in horrible third-world countries like Canada. My mistake!