Skip to comments.Dexamethasone vs. Hydroxychloroquine: The Race for a Coronavirus Cure Shows Why Politics and Science Don't Mix
Posted on 06/20/2020 7:54:27 PM PDT by SeekAndFind
Earlier this week researchers in the U.K reported that the inexpensive and commonly‐used steroid dexamethasone reduced the fatality rate of COVID-19 patients on ventilators by 30 percent. This wonderful news makes a lot of sense to health care practitioners.
As we learn more about the workings of the novel coronavirus we now understand that many of the most critical cases result from an over‐reaction of the patients immune system (called a cytokine storm) causing inflammation and destruction of tissues and organs that can ultimately lead to death. Steroids have long been employed to counteract acute and chronic immune and hyperimmune responses. Aware of this, many clinicians managing critically ill COVID-19 patients who continue to deteriorate have intuitively resorted to steroids in a last‐ditch effort to rescue them. The results from these clinical trials in the U.K. validate that intuition and provide hope that we can further reduce COVID-19s fatality rate.
Dexamethasone for the treatment of COVID-19 patients is yet another example of an off‐label use of a drug. The Food and Drug Administration has not approved the drug for the treatment of COVID-19, but clinicians are never prohibited from using a drug in ways not listed on the FDA‐approved label.
The discovery of this off‐label use for dexamethasone was devoid of politics or central planners. It resulted from clinicians applying their shared knowledge and experience to a new challenge and then reporting their findings.
Compare the dexamethasone story with that of hydroxychloroquine. Aware of in vitro and anecdotal clinical evidence that the anti‐inflammatory and anti‐malarial drug hydroxychloroquine, with or without the antibiotic azithromycin, might combat COVID-19 infection, President Trump touted the drug in a March 13 press conference as a potential game changer, and subsequently announced that he is taking it prophylactically.
When the FDA Commissioner stated that hydroxychloroquine was not approved for use in COVID-19 infections, it set off a firestorm in the press. This, in turn, led governors in several states to forbid the off‐label use of hydroxychloroquine for COVID-19 infections except under government‐approved circumstancesa major intrusion of political leaders into the normal practice of medicine.
But the politicization did not stop there. Within a couple of weeks the FDA issued an Emergency Use Authorization to create a national strategic stockpile of hydroxychloroquine (and its related drug, chloroquine) for the treatment of COVID-19 infections.
While a debate still rages among many clinicians, the emerging evidence from clinical trials of hydroxychloroquine treatment for COVID-19 has been generally discouraging. As a result, on June 15, the FDA revoked the Emergency Use Authorization. Now the Department of Health and Human Services finds itself saddled with a national strategic stockpile of 63 million doses of hydroxychloroquine and 2 million doses of chloroquine. And stockpiles created in more than 20 states are similarly in limbo. Floridas governor purchased 1 million doses that have never been used.
As a physician, I cannot state with any confidence if hydroxychloroquine is effective for treating COVID-19. But I have stated vociferously thatdecisions regarding the off‐label use of any drug to treat any condition should be up to health care practitioners and their patients. Politics and central planning only lead to negative unintended consequences.
In the case of hydroxychloroquine, politics and central planning impeded empirical treatment and the collection of evidence on its use in COVID-19 infections. It also distorted the production and supply of hydroxychloroquine and caused needless, wasteful stockpiling.
Meanwhile, empiric use and clinical trials of off‐label dexamethasone for COVID-19 has been uninvolved with politics. Perhaps we should be grateful that President Trump hadnt heard about it.
Look up Amlodipine vs. Covid19. There is a Chinese study that says people with high blood pressure that are on Amlodipine kick the disease with ease. I can attest to it personally.
I pray the virus dissipates into oblivion and to God alone be the glory!
Jeffrey Singer, you forgot the zinc.
When he mentioned the hydroxychloroquine and azithromax, President Trump added “don’t forget the zinc”.
Not Chinese study, may be related.
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Nifedipine and Amlodipine Are Associated With Improved Mortality and Decreased Risk for Intubation and Mechanical Ventilation in Elderly Patients Hospitalized for COVID-19
Isaac Solaimanzadeh 1
PMID: 32411566 PMCID: PMC7219014 DOI: 10.7759/cureus.8069
Free PMC article
Dihydropyridine calcium channel blockers (CCB) are typically used agents in the clinical management of hypertension. Yet, they have also been utilized in the treatment of various pulmonary disorders with vasoconstriction. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been implicated in the development of vasoconstrictive, proinflammatory, and pro-oxidative effects. A retrospective review was conducted on CCB use in hospitalized patients in search of any difference in outcomes related to specific endpoints: survival to discharge and progression of disease leading to intubation and mechanical ventilation. The electronic medical records for all patients that tested positive for SARS-CoV-2 that were at or above the age of 65 and that expired or survived to discharge from a community hospital in Brooklyn, NY, between the start of the public health crisis due to the viral disease up until April 13, 2020, were included. Of the 77 patients that were identified, 18 survived until discharge and 59 expired. Seven patients from the expired group were excluded since they died within one day of presentation to the hospital. Five patients were excluded from the expired group since their age was above that of the eldest patient in the survival group (89 years old). With 65 patients left, 24 were found to have been administered either amlodipine or nifedipine (CCB group) and 41 were not (No-CCB group). Patients treated with a CCB were significantly more likely to survive than those not treated with a CCB: 12 (50%) survived and 12 expired in the CCB group vs. six (14.6%) that survived and 35 (85.4%) that expired in the No-CCB treatment group (P<.01; p=0.0036). CCB patients were also significantly less likely to undergo intubation and mechanical ventilation. Only one patient (4.2%) was intubated in the CCB group whereas 16 (39.0%) were intubated in the No-CCB treatment group (P<.01; p=0.0026). Nifedipine and amlodipine were found to be associated with significantly improved mortality and a decreased risk for intubation and mechanical ventilation in elderly patients hospitalized with COVID-19. Further clinical studies are warranted. Including either nifedipine or amlodipine in medication regimens for elderly patients with hypertension hospitalized for COVID-19 may be considered.
Keywords: amlodipine; calcium channel blockers; coronavirus disease (covid-19); covid-2019; high altitude pulmonary edema; hypoxia; nifedipine; pulmonary artery hypertension; pulmonary vasoconstriction; pulmonary vasodilation.
Copyright © 2020, Solaimanzadeh et al.
Conflict of interest statement
The authors have declared that no competing interests exist.
Paddy Irish wrote:
“Look up Amlodipine vs. Covid19. There is a Chinese study that says people with high blood pressure that are on Amlodipine kick the disease with ease. I can attest to it personally.”
You take amlodipine regularly, then at some point you caught the virus, and was able to give it the boot?
I take amlodipine every day for high blood pressure and it has worked fantastic. Back in April I was running a fever one day and was kind of worried. I live alone, and work from home so I gave it another day. I started to get the Chris Cuomo symptoms of chills and I was really worried because I’m in my mid 50s with HBP. Well I took my usual dose of amlo and after 2 days all symptoms were gone except for mild fever.
Do you usually take zinc also?
Medicine and government needed a divorce since the ACA “tax law.”
“As a physician, I cannot state with any confidence if hydroxychloroquine is effective for treating COVID-19.”
Well, Jeffrey Singer, you must really suck at doing research, because there are boatloads of stories and cases showing amazing results with hydroxychloroquine.
This is great to know. I started taking Amlodopine about six months ago for HBP, and I’m also in my late 50’s.
“Well I took my usual dose of amlo and after 2 days all symptoms were gone except for mild fever.”
Now there’s a nice strictly controlled scientific study. /s
I take it also and am sick right now.
I take Amlodipine daily, a small dosage. Add this info to my type O neg blood and the vitamin C & D I also take and I’m feeling pretty good.
I forgot to mention the zinc. I take zinc, too.
Curios to know your age and weight?
The various steroids being mentioned work for the cytokine storm, where the body's immune system goes into overdrive and kills you.
Next thing we know- someone will declre that Peanut butter will cure the virus...
I don’t trust any of these blowhards- especially Fauci & Bill Gates.
The Wuhan virus studies using dexamethasone have NOT shown that those studies (a) compared the use of dexamethasone vs the use of other already in use steroids or simply (b) compared the use of dexamethasone vs no steroid medicines at all. Of course the use of dexamethasone would show vast improvement against the cytokine storm compared to giving patients no steroids at all. But that would not prove its case. It has to be compared against other steroids, other steroids already in use with Wuhan virus cases, cases already being treated - and saved - with other steroids.
There is one manufacturer/owner of dexamethasone - in Germany. Of course it is cheap now. For how long?
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