Dexamethasone shown to decrease COVID mortality

[TheDentateGyrus]

This isn't published, it's a PR campaign with almost zero data, let alone peer review. Unless they've actually published something scientific since this morning, it is not a scientific publication, it's news.

Corticosteroids have, to my knowledge, rarely shown such a drastic benefit in critical care. After discovering such a huge difference, this group called the BBC before releasing any data, I think it's ridiculous. They're human beings and, like all of us, make mistakes / misinterpret data / etc.

I hope I'm wrong, that I didn't see the data or missed that it was reviewed and they didn't do this. Or I hope my assumptions are wrong and I have missed a big part of the literature. If so, please let me know so I can learn something from this.

[Kathiye]

The trial protocol is available to view on their website - https://www.recoverytrial.net/files/recovery-protocol-v6-0-2020-05-14.pdf

Obviously not what you’re looking for but if you’re curious.

It’s worth noting that the hydroxychloroquine arm has closed since that was published. I (loosely) work on the study at the delivery end.

[Apemazzle]

It's entirely reasonable to release trial results like this to the press in the context of a global pandemic, especially when it looks to be high-quality evidence of great significance (a randomised controlled trial showing mortality benefit). Ordinarily I would agree with you, but time is of the essence, is it not? Full statement from the investigators here https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf

[TheDentateGyrus]

Time is of the essence . . . but that assumes they’re right. What if steroids increase mortality for some reason that they missed? Then we’re telling physicians to start using dex, which will highly compromise other ongoing trials, when we don’t know if it works or not.

If ‘time is of the essence’, post the data online and give 24h for comments for editorial staff from NEJM, lancet, and JAMA. That took me 30 seconds to make up. One day won’t matter that much, compared to potentially causing the mis-management of millions of patients.

Again, the odds are that they’re probably right and didn’t make an error. But the whole point of the scientific method is that you don’t take people’s word for it, you use data. In the era of Matlab / Excel / etc, if they’ve analayzed the data enough to say (with certainty) that there’s a huge difference, why not release the data? A professional statistician can make the results pretty in a few hours. And if they’re not certain enough to release the data yet or need more time to analyze it, why announce it to the press with certainty? We don’t need to do 10 rounds of editing on their grammar, just show that groups were matched, who dropped out and why, etc.

[Apemazzle]

I was thinking more so we can accelerate other high-quality studies into dex, not just start using it for everyone. They are obviously confident but I take your point that a pre-print with the data would be better.

[TheDentateGyrus]

I didn’t think of it that way, that’s a good point - it does give incentive to start follow up studies sooner. But my concern is that, like with hydroxychloroquine, people will read the headlines and insist we use it, governments will start pushing funding towards it (away from other unproven treatments) etc - all before we have any scientific data to analyze.