Welcome, This is Medicine with Dr. Moran.
I'm Dr. Keith Moran. I've been asked
numerous times about how we're treating
patients hospitalized with the Novel
Coronavirus.
Today I'm going to focus in on one
therapy that's been shown to have a
mortality benefit meaning it saves lives
in certain patients with Covid-19.
This is Dexamethasone which is a sugar
steroid
not an anabolic steroid. Let's get to the
data.
As an introduction these sorts of
steroids are sometimes used as
additional treatment for pneumonias in
general.
Pneumonia is inflammation of the tissues
of the lung
that inflames the air sacs not just the
breathing tubes.
It's an infection that can be caused by
many things
such as bacteria, viruses, or fungus.
The air sacs in the lung can fill with
fluid or pus which leads to cough
with sputum production as well as fever
and difficulty breathing.
Imaging of the lungs such as by chest
X-ray or CT
scans can confirm the clinical
impression of pneumonia.
Steroids are used on a case-by-case
basis for pneumonia but in general
are used with patients in the intensive
care unit at high risk of death.
So it's appropriate to investigate
whether steroids might be helpful in
patients with pneumonia
secondary to this coronavirus.
There was one small trial initially
showing improvement in clinical outcomes
in patients with Covid-19 who were given
a steroid called methylprednisolone.
In china steroids have been recommended
for severe cases but the practice of
whether to give steroids have varied
quite widely across the world
hence the need for a large-scale trial.
We also want to know who will benefit from
this treatment.
The study that was put together to
answer this question is the recovery
trial.
It was reported in the New England
Journal of Medicine
one of our premier medical journals
worldwide.
The study was done in the United Kingdom.
They randomized hospitalized patients
with Sars Cov2 which is the Coronavirus
to either Dexamethasone or usual care.
The steroid they picked was
dexamethasone and this was given either
six milligrams
orally or six milligrams iv once a day
up to 10 days.
As you can see from the slide overall
22.9%
died in the dexamethasone group and 25.7%
percent in the usual care group.
The probability of this occurring by
chance is highly unlikely with the
probability value of
less than 0.001. Which means the chance
that there's desdexomethasone is not
helpful
is one-tenth of a percentage point. This
is very very low.
Death rates did vary depending upon the
patient group.
In patients who needed mechanical
ventilation at the beginning of the
study
in other words a breathing tube had to
be put down into their lungs with oxygen
support by pressure
in that particular group there was
significant improvement with
dexamethasone.
29.3% of patients died in that group
versus 41.4% dying with usual
care.
In patients who needed oxygen at the
beginning of the study but didn't need a
ventilator the numbers were 23.3% for
dexamethasone
and 26.2% for usual care. This also
reached statistical significance
lastly for patients that did not require
oxygen at baseline.
Dexamethasone treatment led to a death
rate of 17.8% percent
and with usual care 14%. This did not
reach statistical significance
but obviously suggests that there might
be possible harm in this group.
Now I've added a third column in my
chart which is the number needed to
treat.
What this tells us is how many people do
you need to treat to prevent a single
death. If you look at patients who are on a
mechanical ventilation at the beginning
of the study
the chance of them dying was 41.4%
but came down to 29.3% which is a
reduction of 12.1. The inverse of 12.1 is 8.2
meaning that if we treat 8.2 people on
mechanical ventilators with
Dexamethasone
one life will be saved. You can see that
if someone is on oxygen but didn't need
ventilation we'd have to treat 34 people
in order to save one life.
The bottom line or take away here is
that if you're in the hospital with
Covid-19
and you need oxygen Dexamethasone
therapy will reduce the odds of you
dying.
This is greater if you're on a
mechanical ventilator.
Down in the description there's a link
to the study.
Thanks for joining us today I'm Dr. Keith
Moran.
This is Zorro. Remember get healthy
and stay healthy.
