@demon54 “Dexamethasone is readily available and cheap. It has been shown to improve the outcome of patients on ventilators with Covid 19 by over 30% and all those hospitalised with Covid19 by over 20%.The recent boost of MSB share price on the back of hopes in Covid 19 treatment now seems to be unwarranted in the light of the evidence of this steroid treatment.”. I will take you at your word as regards your medical background. Some of the points you make are valid in particular the cheap pricing and wide availability ...but at the same time I do not agree with your conclusion which i think is flawed. Let me explain why. I am in agreement that physicians already have recourse to steroids. Frankly, any long term Mesoblast shareholder is acutely aware of the numerous medical complications which make steroid refractory patients seek alternative therapies, which is why Ryoncil is a treatment for steroid refractory acute GVHD.
On first looks at the trial results of patients administered Dexamethasone in a recent ARDS trial of sceptic patients looks pretty impressive compared to the placebo....
https://emcrit.org/pulmcrit/dexa-ards/
The meta data, however, is a little less convincing, with some studies reportedly showing a mortality benefit whereas others don’t.
If you read the link above, which comprehensively covers the subject, there are several key conclusions drawn from the study outcomes relating to Dexamethasone (DM), to date.
1) DM IS NOT TO BE USED AS A SALVAGE THERAPY ... INDEED IT SHOULD BE ADMINISTERED WITHIN 48 HOURS OF ARRIVAL IN ICU
2) DM HAS ACHIEVED A REASONABLE REDUCTION IN VENTILATOR DAYS BUT NOT IMO IN THE SAME LEAGUE AS THE COMPASSIONATE USE RESULTS OF MESENCHYMAL BASED THERAPIES. IMO, EVEN THE LESS POTENT MULTISTEM (ATHERSYS) WOULD OUTPERFORM DM
3) SIDE EFFECTS OF USING DM INCLUDE HYPERGLYCEMIA FOR THE MAJORITY OF PATIENTS .WHICH IS NOT GREAT CONSIDERING ONE OF THE BIGGEST CONDITIONS AFFECTING MORTALITY OUTCOMES FOR COVID 19 IS DIABETES>
4) The data for the DM ARDS trial was for patients with a PaO2/Fi O2 ratio (blood oxygenation level) less than or equal to 200 (this includes moderate). Mesoblast’s trial results in Mount Sinai were based on salvage therapy patients many of whom had been on ventilators for weeks...and our clinical trials are only enrolling the most most severely affected patients with PaO2/FiO2 ratios of 100 or less. So lets be clear , the outstanding results announced by MESOBLAST were for more critically ill patients than those in the DM studies.
5) JUDGING BY SMALL RCT TRIALS IN CHINA FOR MESENCHYMAL BASED TREATMENTS ON SIMILAR DOSING PARAMETERS AND OUR COMPASSIONATE USE RESULTS IN NYC , I AM CONFIDENT THAT REMESTEMCEL-L WILL ACHIEVE MUCH LOWER RATES OF MORTALITY IN TREATING SEVERE PATIENTS IN COMPARISON TO DM . I estimate the first 30 day interim review by the DRB on the first 90 patients in the Mesoblast RCT will occur about the third week of July. I expect the Mesoblast Phase 3 RCT subsequently to be halted early based on the overwhelming efficacy of the treatment .
6) I am not aware of any paracrine properties resulting from steroid use. In contrast there is every indication from phase 2/3 studies to date that Remestemcel-L has “immune regulatory and regenerative properties”
It is my contention that the randomised controlled phase 3 clinical trial of Remestemcel-L for ARDS will shortly demonstrate far superior results to Dexamethasone for the reasons shown above. In any pharmacoeconomic assessment..the days saved by reducing ICU stays and subsequent occupational therapy...not to mention MORTALITY OUTCOMES ....suggest that Mesoblast’s Remestemcel, will prove a far more effective therapy. For the time being, lets all rejoice that at least we can offer some improvement in mortality rates by having Dexamethasone as a treatment option.
As to the share price of Mesoblast....i would suggest that even a newbie investor would realise the upside is substantial.... on a successful phase 3 read out the shares would in my opinion rise exponentially. I actually believe that Remestemcel will also show great efficacy at much lower dosage levels if used before the onset of the cytokine storm which triggers ARDS. In China , i believe that clinical trials showed that a quarter of the mesenchymal stem cells may be required if administered earlier. This would obviously bring down the costs and make it a much more effective clinical option . Personally, I think the IL6 inhibitor Tocilizumab (Roche) will outperform Dexamethasone ....but I think Remestemcel-L will prove the only real therapy for the most critically ill patients ! Not long to wait . Very excited.
Please do not rely on the accuracy of the facts or opinions expressed in this post when making an investment decision . OP
MSB Price at posting:
$3.89 Sentiment: Buy Disclosure: Held
refractory acute GVHD.
(20min delay)