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COVID-19: Steroid Lowered Mortality / Rural America / Potential Drug-Drug Interaction
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By Kelly Young
Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
https://www.jwatch.org/fw116743/2020/06/16/covid-19-steroid-lowered-mortality-rural-america?query=pfw&jwd=000000703489&jspc=
Check out some of today's developments in COVID-19:
Low-dose dexamethasone: Dexamethasone is associated with reduced mortality risk among patients with severe COVID-19, making it the first drug to show such an effect, according to a statement by trial investigators at the University of Oxford. Over 6000 hospitalized patients were randomized to receive either dexamethasone (6 mg daily) or usual care for 10 days. Dexamethasone was associated with significantly lower risk for death among ventilated patients (rate ratio, 0.65) and other patients receiving oxygen (RR, 0.80), compared with those given usual care. Patients who didn't require respiratory support did not see a benefit. The authors estimate that eight ventilated patients or 25 patients requiring only oxygen would need to be treated with dexamethasone to prevent one death. The results have not been published in a journal yet.
Impact in rural America: Rural areas in the U.S. could face a greater strain on their healthcare systems and a higher per capita burden of COVID-19 than urban areas, a modeling study in Nature Medicine projects. Areas in need of additional support include much of the western U.S., the northern Midwest, Florida, and northern New England. The authors conclude: "Our findings suggest that ensuring equitable allocation of medical care and public health resources to communities away from major population centers will be crucial as the country attempts to mitigate the consequences of the ongoing COVID-19 epidemic."
Potential drug-drug interaction: The FDA is warning that remdesivir shouldn't be used alongside hydroxychloroquine or chloroquine as it may result in lower antiviral activity for remdesivir. The announcement was based on lab studies, but the interaction has not been observed in the clinical setting. On Monday, the FDA pulled the emergency use authorization for hydroxychloroquine and chloroquine for COVID-19.
Dexamethasone news release (Free)
Protocol of RECOVERY trial, which includes dexamethasone arm (Free PDF)
Study on impact in rural America in Nature Medicine (Free)
FDA MedWatch safety alert on potential drug-drug interaction (Free)
NEJM Journal Watch COVID-19 page (Free)
NEJM COVID-19 page (Free)
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