Last week, a press released provided initial and promising results from a large scale trial of the corticosteroid dexamethasone in hospitalized COVID patients. Today the authors released a full report: https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1.full.pdf">https://www.medrxiv.org/content/1...
As a reminder, dexamethasone was just one arm of the trial. The primary outcome measure was 28-day mortality.

I& #39;m pleased to see that the subgroup analysis reported, namely effect of dexamethasone according to level of respiratory support, was pre-specified.
The randomization ended up with an age imbalance which was corrected. Though the correction was not part of the pre-registration, this seems entirely reasonable to me.
I do not have the expertise in trial design to comment on the decision to stop enrollment. That said, this seems appropriate and I do not see red flags.
In the press release I was surprised the survival difference between ventilators (40%/29% with/without dexamethasone), supplemental oxygen (25%/22%), and neither (13%/17%) was pretty narrow.

Here& #39;s a possible clue: ventilated patients were 10 years younger. I don& #39;t know why.
Secondary measures: Dexamethasone also showed small but significant benefits on time to discharge and probability of avoiding mechanical ventilation. These are overall differences; I do not believe these secondary measures are broken down by breathing support.
For me the take-home is that there are no big surprises relative to what we learned from the press release.

The trial gives a strong indication that dexamethasone is beneficial in hospitalized patients requiring respiratory support (O2 or vent).
As noted in the press release, patients not on respiratory support fared *worse* when treated with dexamethasone. The difference is not statistically significant, but concerning.

"There was no benefit (and the possibility of harm) among
patients who did not require oxygen."
As I noted before, the trial showed that dexamethasone helps the very ill. It& #39;s not for mild illness.

Taking it won& #39;t prevent you from getting COVID.

Nor, if you have COVID, will it prevent you from being hospitalized.

Nor is it a panacea even for the very ill.
Finally, @EricMeyerowitz has a more detailed analysis of the paper in this thread (h/t @CovidPath) that makes for good reading, particularly if you& #39;ve read the paper and want a deeper dive. https://twitter.com/EricMeyerowitz/status/1275263218965979141">https://twitter.com/EricMeyer...
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