Twitter’s Mixed Response to Dexamethasone Preprint

RECOVERY researchers posted a preprint of their dexamethasone trial results on the MedRxiv server this week. The findings suggest the steroid reduces mortality among the sickest COVID-19 patients. But some readers on Twitter remain skeptical, saying clinicians need more data — and the data need to be peer reviewed.

One of the trialists, Martin Landray, MBChB, PhD, Nuffield Department of Population Health, University of Oxford, UK, announced the data release on Twitter earlier this week.

“Pre-print now available. Huge credit to all those #NHS who have made this possible – most of all to the patients, their families and their loved ones. Thank you all,” the epidemiologist tweeted.

The study authors report that dexamethasone seems to reduce inflammation caused by the immune system. The drug reduced deaths of patients on ventilators by 29%, and deaths of patients on oxygen by 21.5%, they write in the preprint. The researchers compared data from 2104 severely ill coronavirus patients who received a daily, low dose of dexamethasone, orally or intravenously, with outcomes from 4321 patients who received standard care.

“Med Twitter” reacted swiftly.

Some of those posting on Twitter welcomed the news of a potentially safe, inexpensive drug to help in the fight against the novel coronavirus.

“Oh look. The RECOVERY preprint is out. I am glad I was a staunch advocate we adopt this asap as it was not a typical ‘medicine by PR’ because the manuscript is sound…Change your practice now,” tweeted oncologist Vinay Prasad, MD, from the University of California San Francisco.

Prasad’s tweet references a press release on the paper distributed last week and widely covered in the media that declared, “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients.”

However, not everyone was quick to appreciate the authority of the preprint. As with the press release, many Twitter users continued to push back against the idea of changing practice before seeing the fully published study.

“… My initial concern, after a very brief skim of the article, is that the raw data and statistical methods (including relevant code/parameters) aren’t available for reproducibility purposes. Could the preprint please be updated with links to these resources?” the genomicist Steve Moss queried.

And others underscored the importance of knowing when to use the drug — and when not to use it.

“This is key: the steroid drug dexamethasone likely harmful if taken in early illness. But dexamethasone can prevent mortality in late #COVID19 illness when on oxygen or ventilator. Timing of the use is EVERYTHING!” tweeted Harvard epidemiologist and public health scientist Eric Feigl-Ding.

In addition, many Twitter users said it was important to proceed with caution to avoid a recurrence of recent missteps that resulted from rushing ahead of data or normal scientific process. For example, some pointed to recent high profile retractions in major scientific journals such as The Lancet and New England Journal of Medicine, as well as the Food and Drug Administration withdrawal of its emergency use authorization for hydroxychloroquine and chloroquine, drugs once touted by the federal government as viable COVID-19 treatment.

https://www.medscape.com/viewarticle/933012