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Notebook Medicine

A steroid solution

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Medicine

A steroid solution

New research suggests that, for many patients, an asthma medication could promote COVID-19 recovery

Finding effective medical treatments for COVID-19 has been a slog, but researchers are finally making progress. Last year, U.K. researchers demonstrated that the steroid dexamethasone can help patients who have severe cases of COVID-19. Dexamethasone was ineffective in less severe stages of the disease, but scientific detective work has now identified a related steroid that can help prevent the worst cases. 

Asthmatics were a clue to the discovery: We’d expect them to struggle against a respiratory bug, but instead, they fare better than average when fighting COVID-19. Doctors wondered: Could the inhaled steroids they use to manage their condition be the key?

To answer this question, researchers with the STOIC (Steroids in COVID-19) trial assessed a drug called budesonide, commonly prescribed to asthmatics under the trade name Pulmicort. The researchers asked whether giving this steroid within seven days of the onset of mild COVID-19 symptoms might prevent the disease from turning severe. (They defined prevention as avoiding a trip to the urgent care, ER, or hospital.) 

The study results left little doubt: Of the roughly 70 patients who received the usual care, 10 worsened. Of the equivalent number on budesonide, only one did. Budesonide also made COVID-19 patients less likely to develop fever, and among those who did, it reduced the number of days with fever.

In short, the drug helps.

The news gets even better. Not only does budesonide help, but it’s cheap and common. As an “essential drug” the World Health Organization believes every country should make widely available, budesonide has helped generations of asthmatics keep their sensitive lung passages calm. It doesn’t last long in the body, so patients must take it twice a day, often for decades. That means the drug, whose patent expired in the late 1970s, is already in wide use.

Researchers measuring a medication’s effectiveness sometimes refer to a figure called the “number needed to treat,” or NNT—the number of patients, statistically speaking, who’d have to receive a given drug or treatment in order for one patient to benefit. For inhaled budesonide, the STOIC study’s authors calculated an NNT of 8. For every eight patients receiving the drug for mild COVID-19, the authors expected one patient to avoid worsening as a result.

Strong treatments normally have a much lower NNT—a drug that benefits every other patient, for example, has an NNT of 2. But the “usually mild, occasionally deadly” nature of COVID-19 may confuse the statistical analysis here. In the study, 6 out of 7 patients who didn’t get the drug still didn’t worsen, meaning the NNT could not have been less than 7. That’s not a surprise with this disease. The researchers’ analysis is sober, and resists the temptation to oversell the results.

Budesonide thus isn’t quite the “silver bullet” that its earliest promoters promised last summer, but it is now the first drug shown by quality research to prevent mild cases of COVID-19 from becoming severe or fatal cases. 

The study, involving a team from the University of Oxford, is currently awaiting peer review. Still, Oxford’s lengthy track record of quality research argues strongly for believing it in the meantime. The evidence is certainly enough that if I were to develop symptoms, I would start taking budesonide myself.

One more question to address concerns the balance of accuracy and speed in the research world. The STOIC team originally expected its budesonide results by last September, yet even the online preprint article on MedRxiv wasn’t published until Feb. 8. Such delays are common, but having even a mediocre COVID-19 treatment last September might have saved many lives. We’ll discuss that delay problem in a future article.

Comments

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  • HANNAH.
    Posted: Thu, 02/18/2021 03:11 pm

    Thank you for focusing on treatment – because of the dilemma of deciding on vaccination. 

    “Will I or won’t I get the corona virus vaccine?” Through a video with a clear explanation, I now understand what the vaccine is and how it works. As a result, I have decided that I won’t get the corona virus vaccine. Please view this video, starting at about 4:50 through 20:05, and make your own decision – for yourselves and your families.

    Dr. Sherri Tenpenny explains how the ... COVID vaccines will start working in 3-6 months

  • RC
    Posted: Thu, 02/18/2021 06:56 pm

    As we are all concerned about the safety of the covide-19 vaccines I did a little research into the source on Hannah’s link. See the excerpt (from the web page) and the source below:   

    Dr. Tenpenny on Vaccines and Current Events

    233,41 Facebook page likes

    The Facebook Page of Dr. Sherri Tenpenny, a noted anti-vaccine activist.

    Examples of vaccine misinformation:

    Sept. 12, 2020, post linking to an article falsely reporting that a COVID-19 vaccine would alter your DNA and make you “transhuman.”

    July 29, 2020, post with a link to a video interview in which Tenpenny states that a COVID-19 vaccine may “encode” the virus with “various things” that can be activated later, such as 5G technology.

    NewsGuard emailed an address listed on the page seeking comment on the above posts, but did not receive a response.

    https://www.newsguardtech.com/special-report-covid-19-vaccine-misinformation/

    If your argument requires a video, I will pass. I have to have the written word, to avoid the emotion laced feelings, which are used as a substitute for the truth. Provide documentation and sources I will listen.  Dr. Tenpenny fails my truth test and lacks credibility.  

  • HANNAH.
    Posted: Thu, 02/18/2021 10:48 pm

    Thank you, RC, for challenging me to provide documentation and sources that you may consider more credible. I hope that the following will be helpful. 

    Dr. Lee Merritt discusses prevention and treatment of the coronavirus (SARS-CoV-2). Regarding someone receiving the experimental vaccines, she doesn’t say “yes” or “no” but is adamant that patients who receive them do so with “informed consent.” Then she informs us about the vaccines: how they work and the results of the animal studies for the SARS and MERS coronaviruses. 

    For “the written word” you require, Professor Dolores Cahill refers to a report on vaccines for SARS-CoV (Immunization with SARS Coronavirus Vaccines Leads to Pulmonary Immunopathology on Challenge with the SARS Virus). Here’s the link to the research article

    Dr. Simone Gold  states that “antibody dependent enhancement [ADE]” (also explained by Dr. Merritt) “even has its own Wikipedia page.” Here’s the link to the ADE article. (I think that Dr. Sherri Tenpenny explained it more simply in the video I referenced above.) 

    Like Dr. Merritt, I desire informed consent. In my situation, the information leads me to refuse the vaccination.

  • RC
    Posted: Mon, 02/22/2021 12:19 am

    HANNAH, the following is a response to your new sources of information:

    The Dr Lee Merritt link is to a video, no documentation.  

    The Professor Cahill link is to a video, no documentation.

    The link to the research article said, “page not found”. (provide the article title, if it is out there, I will find it)  

    Dr Simon Gold – this is a link to, “America’s Frontline Doctors”. This organization has already been discredited. Multiple web pages and articles show they are not a credible source.

    I read the Wikipedia article. “Antibody-dependent enhancement”.  There are two warnings, one is related to using non-free copy written sources. And the second has to do with the need for more medical references or relying too heavily on primary sources. This reduces the reliance on the truth of this article. The last section is titled,” Culture and society”, it says while the ADE is a theoretical possibility, by way of the actual clinical trials, the Covid-19 vaccines are not resulting in ADE occurring.

  • HANNAH.
    Posted: Mon, 02/22/2021 11:13 pm

    RC, I’m sorry that the research article link went to “Page Not Found.” Thanks for letting me know. I’ve copied it again without editing. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035421 Also, here’s the title of the article: Immunization with SARS Coronavirus Vaccines Leads to Pulmonary Immunopathology on Challenge with the SARS Virus

  • CJ
    Posted: Fri, 02/19/2021 08:27 am

    Every vaccination I have received was with informed consent. We are grateful to the research teams and volunteers who help develop them - from small pox to annual flu. We are equally grateful to have received both dosages of Pfizer's covid vaccine. 

  • BECKY KEMPF
    Posted: Fri, 02/19/2021 10:02 am

    Glad to see World Magazine FINALLY talking about some of the safe, effective (and cheap) treatments for COVID!!

  • RH
    Posted: Fri, 02/19/2021 07:31 pm

    Vaccinations are one of the greatest achievements of medicine in the last 100 years (along with the development of antibiotics).  The two vaccines currently FDA approved for prevention of disease caused by SARS-CoV-2 have been rigorously tested and are both effective and safe.  As a recently retired physician, I have had the time and opportunity to research these two vaccines and am convinced that all eligible people should indeed proceed with vaccination for their health benefit and for the benefit of others.

  • Laura Ayscue
    Posted: Mon, 02/22/2021 08:06 am

    Some doctors were using this drug to treat patients and were saving lives back in September.  It is disingenuous to say if we knew about this in September think how many more lives might have been saved.  Rather it should be said, "if treatment options had been less politicized and doctors encouraged to practice the 'art' of medicine this drug would have had much wider usage in advance of the ivy tower study confirming what hard working qualified doctors in the trenches already knew."

  • BL
    Posted: Mon, 02/22/2021 04:39 pm

    I appreciate world news keeping us informed about many different topics including the COVID-19 pandemic that is affecting the world as well as the church so strongly.

     

    I want to point out that the study does not show a reduction in deaths in the treated arm forces the untreated arm. The study shows a reduction in severity and a quickening to return to health by one day in the treated versus the untreated. The study was not powered (large enough in numbers) to show a difference in mortality. As a front line physician in this battle (emergency room doctor in a small town in Oklahoma) I would welcome any medicine that reduced mortality or even reduced the need for hospital or ICU admission. 

  • RC
    Posted: Fri, 02/26/2021 11:53 am

    This is my response to Hannah’s reply to my comment.

    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035421

    Read this sentence (below) from the (linked) paper you referenced.

    “Limitations of the present studies include their performance in mice only and uncertainty of the relevance of rodent models to SARS-CoV vaccines in humans.”

    Two points from this sentence: 1. The studies then in process had limitations, thus inconclusive. 2 The problem occurred with mice and they say they have no idea if it would occur with humans.  

    This research paper was written in 2012. Thus, EIGHT years ago. Way more than enough time to overcome the Pulmonary issue.

    This had to do with a SARS vaccine in the early research process, not with the Covid-19 vaccines which are way beyond that point.  

    Current research papers (dated in 2020) mention the Pulmonary issue, (see link below) but do not indicate that Pulmonary issue as mentioned in the 2012 paper is a problem.

    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035421

    In conclusion, the study paper you mentioned, no longer applies as the issues have been overcome. Note that the Covid-19 vaccines have reached human trials and I do not see mention of Pulmonary issue being of any concern.