What Kevin Drum calls “evil Dex” has some good outcomes in the UK:
The low-dose steroid treatment dexamethasone is a major breakthrough in the fight against the deadly virus, UK experts say.
The drug is part of the world’s biggest trial testing existing treatments to see if they also work for coronavirus.
It cut the risk of death by a third for patients on ventilators. For those on oxygen, it cut deaths by a fifth.
It’s “cheap as chips” ($6.31 for a course of treatment) and widely available. It only works during the serious phase of the disease, and would be administered in a hospital setting.
Update: Hmm, this was based on a press release, not a refereed paper. So take it with grain of salt.
Roger Moore
This is good to hear. We knew that a big part of the danger in the serious stage of the disease was from the patient’s immune system getting out of control and attacking their own tissue, so it makes sense that an immune suppressing drug would help. It’s just going to be really important to get the dose right.
WaterGirl
How much do you want to bet that the price of a dose will go sky-high now that there may be reason to think this could help with COVID?
download my app in the app store mistermix
@WaterGirl: Well that $6.31 price is what it costs the NHS. In the US, it’s probably $63.10 or $631.00, and it will double or triple as soon as the news hits.
Amir Khalid
@WaterGirl:
It shouldn’t for a generic drug, at least not in the UK.
randy khan
Not in this story, but in another I saw, apparently the NHS has been stockpiling the drug for a while based on preliminary results of the trial, so I would take this pretty seriously.
Barbara
@Roger Moore: Yes, but many other doctors have considered this and the early reports were not especially encouraging. It’s possible that people are now being treated earlier in the disease cycle, and that makes a big difference. I would definitely wait to see how this one pans out.
What Have the Romans Ever Done for Us?
A study out of Russia seems to be showing that Avigan (favipiravir) is significantly effective – seems close to if not as effective as the Remdesivir studies have shown. Granted, that’s not a silver bullet but anything that helps is a major step forward.
I’m skeptical of anything coming out of Russia, but China also has stated it’s effective. UMass General started a clinical trial of it in early to mid April…would think some preliminary results would be out by now or coming very soon, but so far I haven’t seen any. I’m hoping we can find something that works to reduce viral load (favipiravir is in the same class as Remdesivir but is available in oral dose so could be taken at home in the early stage of infection, and is much easier to manufacture) and theraputics to manage the worst symptoms so we can dramatically lower the mortality rate.
Barbara
@download my app in the app store mistermix: Possibly, however, this is a drug that is manufactured by many generic companies, and it is widely used. It’s much more common than cloroquine. It is also given orally. Getting a monopoly on generics in order to spike the price takes time. In the short run, it should be okay. Who knows in the long run.
kindness
That’s funny. Kevin always talks about it like he’s eating speed. He doesn’t sleep the days he takes it so he’s used that to go out and take night photos rather than just spin his wheels at home. I don’t always agree with Kevin (his hatred of passenger trains & high speed rail must be an Orange County thing) but I keep reading him. Glad he’s around to write.
hells littlest angel
A promising new treatment from a country with a fucking simpleton at the head of a government which horribly botched its response to the pandemic?
Been there, done that.
Matt McIrvin
I tend to be skeptical of any one report about an effective treatment or vaccine candidate–but if this is like past diseases, the accumulation of results will eventually lead to real improvements, and we might not even hear much about them until they’ve already happened. It’s possible that what we eventually get is something like the combination of drugs administered together that eventually turned HIV into a manageable infection. Of course, that took a very long time to come about.
meander
Fresh Air recently had an interview with a doctor who was diagnosed with Castleman disease while a medical student. It’s a horrific syndrome, requiring him to be hospitalized for several weeks when he has an ‘attack’ of the disease. Not satisfied with what his doctors were telling him (not surprising, because this is a rare disease), he did his own research and eventually set up a collaborative network to gather potential solutions from around the world (i.e., linking up researchers who might ordinarily never meet).
Recently he has taken these ideas and started the “CORONA database” to track potential treatments. Here’s Dr. Fajgenbaum explaining his motivation:
It’s a great interview, well worth downloading or streaming.
Barbara
@Matt McIrvin: Actually, considering how new and novel HIV was, it came about with lightning speed. I know that it doesn’t seem like that if you were infected and were clearly in a race against time, but AZT was approved within five years of the HIV virus being discovered. Think about diseases that have been known for much longer, and for which there are still no cures and sometimes no treatment at all. One advantage we have with COVID-19 is that people had already been studying SARS and MERS and had a jump start on the molecular properties of related CVs.
Sab
@hells littlest angel: Well aren’t we cynical? ( I comment cynically, with no reason whatever to think you are wrong)
rikyrah
I will take any positive news that can be found.
meander
@Barbara: We can be sure that the intellectual property teams at Big Pharma are writing patent applications like crazy for combinations of drugs or time-release concepts that they think can get past the patent examiners. For better or worse, you can file for a patent on something that you have never built and don’t know if it works or not. The basic requirements are that it be novel, useful, and non-obvious.
Big Pharma might also be forging agreements with manufacturers of generics for exclusive rights or some other supply-limiting or price hiking mechanisms.
Doug
This tweet has links to PDFs of the study protocol and the statistical analysis plan. Not a full paper, but more substantial than the press release.
https://twitter.com/vintweeta/status/1272892799189495808
Matt McIrvin
@meander: I suppose one big difference from Castleman disease is that with COVID-19 he surely has no problem with even interesting people in researching the disease, since it is the opposite of rare.
JR
Feeling pretty fucking burned by Raoult et al., I’m going to wait and see on this one.
Matt McIrvin
@Barbara: The first drugs with some effectiveness appeared within just a few years, but the really dramatic progress came once there were enough types of drugs that it was possible to do the modern combination therapy, which was about 15 years after AIDS became widely known. It was gradual progress eventually leading to a sort of phase change.
That is still fast as these things go–but that rate of progress is not necessarily great news if people are waiting for something to fix COVID-19’s sweeping effects on society. Of course COVID is very different, doesn’t seem to mutate as rapidly as HIV, which probably affects what will work.
burnspbesq
@meander:
if we actually made a good-faith effort to enforce the existing antitrust laws, those shenanigans would be far more difficult to accomplish. Yet another reason to vote Dem.
burnspbesq
OT:
Commerce Dept. says retail sales in May were up 17.7 percent over April.
I’m sure it’s just a coincidence that new COVID cases are up in June.
JCJ
I would have thought corticosteroids would have been tried early on. Prednisone and methylprednisolone are often used for exacerbations of COPD.
Here is another article using radiation for treatment of the inflammatory response
https://www.forbes.com/sites/jamesconca/2020/06/12/1st-human-trial-successfully-treated-covid-19-using-low-doses-of-radiation/?fbclid=IwAR0Nsb_BuA7hxYvWWwk0NSl3PIXNNrleSxAvEBMNXjnk6G1QWcIyTn0W67s#6f8c91cbdc69
Roger Moore
@burnspbesq:
Yeah, there are some common practices in the pharma industry that don’t pass the smell test, e.g. companies with drugs going off patent paying potential generic competitors not to enter the market. More generally, I think it’s probably a mistake to give patent protection to new formulations of existing drugs.
IMO, the drug business is such an awful one from an anti-trust standpoint because there are both patent and regulatory barriers to entry. I don’t want to give up the strict regulation- drug safety is a real issue- which means we need to look more carefully at drug patents. Of course it would also help if our medical system were generally more focused on providing good care to everyone and less focused on providing ground-breaking care to people who can afford the very best.
Victor Matheson
@Matt McIrvin: Agreed. Remember, there are actually multiple ways the world can return to normal.
Everyone seems to be putting our hopes in 3, but 4 really could be just as realistic.
Barbara
@meander: I just don’t feel like engaging on the various obstacles to trying to engineer exclusivity for dexamethasone, a corticosteroid that has been on the market since the early 50s. Sure, I am a cynic, but if you aren’t actually informed about the issue it just comes across as so much naysaying.
Sloane Ranger
The BBC has been reporting this as a successful breakthrough (FWIW) and that the Government is authorising its use to treat Coronavirus.
Either the results have convinced a lot of people of its effectiveness or this has been put out as propaganda…and Boris isn’t that stupid. It would get out and tick off a lot of people. His credibility is already shot. One of the broadsheets was floating Rishi Sunak (Chancellor of the Exchequer) as a potential successor at the weekend.
Another Scott
@kindness: +1
He always calls it “the evil Dex”. But it does seem to be the main thing that helps him fight his cancer.
Helen Branswell seems to think the story is important, also too.
Cheers,
Scott.
jonas
@Victor Matheson: 5. Get everyone to wear masks in public. Like nr. 1, unfortunately, not gonna happen in ‘Murica!, but would be the least painful, quickest, and most cost-effective way of getting the virus under control.
dmsilev
Not surprisingly, Drum has a post up now on the subject with the title “The Evil Dex For the Win!”.
Fair Economist
@Barbara: I get that there are obstacles to exclusivity for generics, but pharma companies have managed to get exclusionary prices for insulin, a drug that was released as a generic (by the wishes of the discoverer) almost 100 years ago.
Aleta
This is live right now (front page of Post site), no paywall.
Trying to do better, faster, than what happened with Agent Orange exposure, for vets who have respiratory problems after exposure to burn pits in Iraq and other problems.
Aleta
@Aleta: Another link if needed
Barbara
@Fair Economist: Right. I am not discounting potential issues at all. I am just saying that it’s a complex and rarely a short-term strategy.
Timill
@dmsilev: https://www.motherjones.com/kevin-drum/2020/06/the-evil-dex-for-the-win/
Barbara
@Barbara: Just following up to mention a big difference between COVID-19 and diabetes — diabetes is chronic. The go to business strategy of large pharma companies revolves around getting IP protection for drugs for chronic conditions. I would not assume that the same incentives are in place for COVID treatments.
trollhattan
@Barbara:
True. Malaria seems to be the toughest nut to crack and considering how long we’ve known both the disease’s source and its method of transmission, it boggles the mind we still have not conquered it.
Bill Arnold
@jonas:
I’d setting for indoors including public transportation (and any other shared enclosed transportation).
There are states where masks/face coverings indoors is mandatory, and compliance is high both from personal observation (southern NY) and stories elsewhere (states local to NY have face coverings orders).
I’ve never seen anyone treat it as a big deal, just put the mask on before going into the building, remove after exiting.
And our numbers/trends and the numbers/trends for the neighboring states look good.
The politicization of this by the US right, probably amplified by foreign influence operations, as usual for wedge-type issues, will kill (has killed) 10s, and in the future perhaps hundreds of thousands of Americans.
Roger Moore
@Fair Economist:
Insulin is an interesting case. The initial use of insulin was for insulin extracted from animals, which was far better than nothing but less than ideal. The first recombinant insulin (insulin made by bacteria rather than animals) was patented because making any human protein for pharmaceutical use was incredibly novel at the time*. That patent was for the naturally occurring human sequence, and since it has expired. The insulin they’re charging such outrageous prices for today has been modified from the natural human sequence to give it different, medically useful properties, e.g. it works faster or longer than natural insulin. It is that additional engineering that justifies granting a patent.
Because the original recombinant insulin patent expired a long time ago, it is legal for companies to make generic insulin. The problem is that the newer, engineered versions of insulin do a better job, so doctors tend to prescribe them instead of the older, cheaper version. It’s a symptom of the underlying problem: we spend too much time and effort working on newer, better treatments that improve things for people with the money to pay for them and not enough on providing essential care for everyone.
*Full disclosure: my employer held that patent. I have personally benefited from the patent royalties, and I have worked professionally with the people named on the patent.
PAM Dirac
@Fair Economist:
There is no legal barrier what so ever to manufacturing insulin as was discovered 100 years ago. The barrier is that it is unlikely that anyone would prescribe it or buy it because the modified forms work dramatically better ( one recent review ). It is certainly possible that companies will try to modify dex to improve its therapeutic actions, but it won’t be quick and it will not affect the ability to make the old dex.
Also, What Roger Moore said.
Barbara
@Roger Moore: Yep. The biggest issue with spikes in the price of insulin relate to newer versions that are still on patent. People have tried to get by with older versions, but I am given to understand that there are real advantages to some newer products.
Another Scott
@Roger Moore: +1
Thanks.
Cheers,
Scott.
The Moar You Know
@What Have the Romans Ever Done for Us?: Neither are trustworthy actors, but Japan has also reported the same thing.
Barbara
@The Moar You Know: Avigan (favipavir) is being studied in Japan. Fuji is the manufacturer. There seems to be a belief that Japan jumped the gun in fast tracking its approval for COVID and that the success has not been nearly what is being claimed for the drug in Russia. Here is an example.
Stacib
@Amir Khalid: I work for a pharma company that makes generic drugs, and this one is in our book. We just got a communication that spoke to the positive results doctors are seeing from this drug. As we are a company who prides themselves on making quality, affordable drugs, I would be super disappointed if we chose to take financial advantage of the covid nightmare.
Kay
We just got 50 nice cotton masks in the mail from Ohio workers comp. According to the insert any Ohio employer who is registered w/workers comp gets them.
We only have 5 employees but good job, Ohio! I’m going to give some away to our customers.
mali muso
Random mask-wearing observation from the hinterlands of Virginia, but I was discouraged to see only around 30% compliance today when I had to make a quick stop at the local mall. Supposedly, we are in a mask-required-indoors state, and there was a “mall cop” at a table near the entrance with free disposable masks, but lots of people just walking by him. sigh.
Frankensteinbeck
@trollhattan:
It’s not really a surprise from a biological perspective. Malaria is a zooparasite, not a virus, except it infests cells like a virus does. That’s a Hell of a thing to cure.
Roger Moore
@Kay:
Go ahead and keep plenty for your staff. Everyone should have enough masks that they can go between laundry days with a clean mask every day.
J R in WV
@mali muso:
I would personally like to see people arrested for failure to abide by health dept requirements in a situation where people are dying. I don’t care about your “freedumb” to breathe on other people, in fact I don’t believe in that particular freedom. Evil, careless, irresponsible — Republicans!
glc
Sounding pretty good to me right now.
https://www.bbc.com/news/health-53061281
https://www.statnews.com/2020/06/16/major-study-finds-common-steroid-reduces-deaths-among-patients-with-severe-covid-19/
STAT also points out that the results are not published or reviewed as yet, but they also take a positive tone, and given how critical they’ve been of weak studies (and weak models) that seems like a good sign.
At least it appears that this time there was an actual study, so there’s that.
burnspbesq
@Another Scott:
i get where Drum is coming from. I fucking hated Prednisone when I had to take it for four days after every chemo session.
Barbara
@burnspbesq: COVID is an acute condition. Use of dexamethasone would presumably be very short term.
MiLilvies
@Roger Moore: Yup. Look up ‘cytokine storm’.
Arclite
It’s $6.31 for a course of treatment until Martin Shkreli buys up the only producer and starts charging $631 for the course.