The authors used a huge database of people who'd been treated for COVID-19, and looked at the associations between mortality and 84 drugs or drug classespic.twitter.com/plb2nc3u1q
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The authors used a huge database of people who'd been treated for COVID-19, and looked at the associations between mortality and 84 drugs or drug classespic.twitter.com/plb2nc3u1q
They found that metformin, nicotine, fluticasone, SNRI, expectorants and ondasetron reduced the risk of death from COVID-19, but given the potential for residual confounding only focused on ondasetronpic.twitter.com/UwsbMV6KGn
The main conclusion is that we should probably try ondasetron as a treatment for COVID-19 in RCTs, which I think is justifiable based on the studypic.twitter.com/FbEVJINeEB
But I think the really interesting part is the initial analysis. It looks like if you test 84 medications for benefit in COVID-19 mortality, 6 positive results will be foundpic.twitter.com/ey7ccuB7si
Thing is, we've been using studies a LOT worse than this one to drive treatments for the whole pandemic. The initial use of ivermectin, HCQ etc in 2020 was based on much less robust evidence than this research
Why is this interesting? I think it shows just how important RCTs of interventions for COVID-19 are If you test a bunch of drugs, you'll see some positives
If 1,000 people run studies on their databases, and you only really see the positive results published, you'll get the false impression that these drugs work against coronavirus even when the evidence is not good at all
This is in no way a critique of this specific paper, whose authors appear to have done a fantastic job, but it is a pretty worrying note for the rest of us
Anyway, ondansetron is a cheap, low-side-effect drug available pretty much everywhere in the world, so if it works for COVID-19 it'd be a brilliant addition to the arsenal
Oh, we mainly give ondansetron to people who aren't sedated/intubated
Hence, associated with a better outcome
I can also think of dexketoprofen and oral nutrition
as associated to better outcomes as well (and for the same reason)
That said, I do believe that this association may happen elsewhere
May not be a false significant result... But I just think it probably isn't causal to what they think it is
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