Has anyone here heard of dexamethasone (corticosteroid) or tocilizumab (IL-6 inhibitor).
Rhetorical questions, but hopefully enough to encourage careful reading and thought.
Il-6 blockers and steroids were thrown at every severe Covid patient this time last year.
What happened?
In aggregate, they made patients worse.
Why is that?
Physicians had failed had the opportunity for careful study (real world science, not by the bench top scientists who have found a stupendous number of in vitro treatments for covid but nearly nothing that works in vivo [The Real World with Real Patients]
With further study what was found?
Dexmathasone in critical patient has a 25% reduction in mortality.
Tocilizumab has a similar impact on severe high-flow nasal cannula but not intubated patients.
The physicians, nurses, RTs, etc will roll their eyes at my remedial pharmacology lesson (or maybe not in agreement), but we need to recall that for every drug there are Five Rs
Right Patient
Right Dose
Right Time
Right Route
Right Medication
Evaluating the "failed" CD12, Leronlimab demonstrated 82% reduction in mortality at day 14, p=0.023.
But but but but but ......what about day 14-28!!! Leronlimab sucks day 14-28.
Why yes, LERONLIMAB NOT ADMINISTERED IS NEARLY COMPLETELY INEFFECTIVE.
Shocking really (not!)
Why is the Leronlimab "wonder drug" such a "failure" in CD12?
Wrong Route - SQ in critical patients ensures that absorption is slow, more than 3 days to peak serum concentration
Wrong Dose - Works great when given (82% better!). Stop giving, stops working. Hello, FDA? Where are doses 3 and 4?
Five Rs - 3 out of 5 right, 2 wrong. Not a surprise results were equivocal after day 14.
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