Discover and read the best of Twitter Threads about #LOPINAVIR
Most recents (15)
IMPORTANT THREAD on #COVIDTreatments - What Works & What Does not. Will be an ongoing threat.
Start with Dr Zarir Udwadia of Mumbai.
Start with Dr Zarir Udwadia of Mumbai.
Link to Dr Udwadia's Video
1st Point: 90000+ Medical papers on Covid. UNFORTUNATELY, big divergence in Observational Studies impact and Real World impact of a rigorous RCT
1st Point: 90000+ Medical papers on Covid. UNFORTUNATELY, big divergence in Observational Studies impact and Real World impact of a rigorous RCT
RCT is Randomized controlled trial.
A Good website is Covid19Primer.com
2) What Works ?
(A) Steroids are essential. #DEXAMETHASONE 6mg/day for Critically ill Covid Patients. Reduces Death by 33/20% for Patients on Ventilators & Oxygen.
A Good website is Covid19Primer.com
2) What Works ?
(A) Steroids are essential. #DEXAMETHASONE 6mg/day for Critically ill Covid Patients. Reduces Death by 33/20% for Patients on Ventilators & Oxygen.
With the .@NIAIDNews #ACCT1 trial final report published on 05 Nov 2020 and the .@WHO's #SolidarityTrial Preliminary report published on 02 December 2020, thought it would be good to take another look at both trials and find ways forward for the patients we are dealing with today
Motivated by a patient I am dealing with who will survive very severe #COVID19 in the setting of transplant, but her father, who was hospitalized earlier than her with moderate COVID, was left to progress and died before her discharge, given #remdesivir only after going on #BiPAP
Here is the link to the prior analysis and I think the new publications give some interesting details which will follow
Pr que cela soit clair #Solidarity auquel #DisCoVeRy fournit les données de mortalité des patients a tiré au sort 1853 patients. La moitié ont eu l'hydroxychloroquine l'autre moitié rien.
Mortalité #HCQ : 11% (104/947)
Mortalité sans #HCQ : 9% (84/906)
medrxiv.org/content/10.110…
Mortalité #HCQ : 11% (104/947)
Mortalité sans #HCQ : 9% (84/906)
medrxiv.org/content/10.110…
A tiré au sort 5451 patients entre remdesivir et pas de remdesivir
Mortalité #Remdesivir : 11% (301/2743)
Mortalité sans #Remdesivir : 11% (303/2708)
Mortalité #Remdesivir : 11% (301/2743)
Mortalité sans #Remdesivir : 11% (303/2708)
A tiré au sort 2771 patients entre lopinavir/ritonavir et pas de lopinavir/ritonavir
Mortalité #Lopinavir/ritonavir : 11% (301/2743)
Mortalité sans #Lopinavir/ritonavir : 11% (303/2708)
Mortalité #Lopinavir/ritonavir : 11% (301/2743)
Mortalité sans #Lopinavir/ritonavir : 11% (303/2708)
The preprints of the #SOLIDARITY trial are out on MedRxiv. While many may lament that all four drugs tested did not show benefit, this is a remarkable trial for many reasons. Thread
First, this was another #MultiArmMultiStage #MAMS study design; @MRCCTU made this highly efficient trial design globally acclaimed with #STAMPEDE. The more recent #RECOVERY trial was another example of this.
@MaxParmarMRCUCL @Prof_Nick_James @PeterHorby @MartinLandray
@MaxParmarMRCUCL @Prof_Nick_James @PeterHorby @MartinLandray
What the #MAMS design does is enable testing multiple drugs simultaneously, flexibility to drop unpromising ones & add new promising ones even midway during the trial. This was crucial in the #COVID__19 pandemic where the situation has been constantly evolving
🔥Les résultat de #Solidarity @WHO, essai mère de #DisCoVeRy sont là
Confirme déception des antiviraux "repositionnés"
Nbre de patients impressionnant : 2750 Remdesivir, 954 Hydroxychloroquine, 1411 Lopinavir, 651 Interferon+Lopinavir, 1412 Interferon, and 4088 no study drug
Confirme déception des antiviraux "repositionnés"
Nbre de patients impressionnant : 2750 Remdesivir, 954 Hydroxychloroquine, 1411 Lopinavir, 651 Interferon+Lopinavir, 1412 Interferon, and 4088 no study drug
405 hôpitaux, 30 pays, c'est ENORME !
On juge de la mortalité, un critère fort
#Hydroxychloroquine : va dans le sens d'augmentation de la mortalité mais NON SIGNIFICATIF donc on ne peut rien dire
On juge de la mortalité, un critère fort
#Hydroxychloroquine : va dans le sens d'augmentation de la mortalité mais NON SIGNIFICATIF donc on ne peut rien dire
#Remdesivir : AUCUNE DIFFERENCE DE MORTALITE, comme on le dit depuis des mois en analysant les différents essais
MEDICAMENTOS PARA #COVID19
Desde diciembre 2019 que se reportó el primer caso de infección por #SARS_CoV_2, han surgido un sinfín de tratamientos para esta infección.
¿Pero cual tiene suficiente evidencia científica?
Abro hilo
Desde diciembre 2019 que se reportó el primer caso de infección por #SARS_CoV_2, han surgido un sinfín de tratamientos para esta infección.
¿Pero cual tiene suficiente evidencia científica?
Abro hilo
Empecemos por dejar en claro varios puntos:
•#COVID19: Enfermedad provocada por la infección #SARSCoV2.
•#SARSCoV2: Nuevo tipo de #coronavirus que por sus siglas en inglés se refiere a 𝘴𝘦𝘷𝘦𝘳𝘦 𝘢𝘤𝘶𝘵𝘦 𝘳𝘦𝘴𝘱𝘪𝘳𝘢𝘵𝘰𝘳𝘺 𝘴𝘺𝘯𝘥𝘳𝘰𝘮𝘦 𝘤𝘰𝘳𝘰𝘯𝘢𝘷𝘪𝘳𝘶𝘴 𝟸
•#COVID19: Enfermedad provocada por la infección #SARSCoV2.
•#SARSCoV2: Nuevo tipo de #coronavirus que por sus siglas en inglés se refiere a 𝘴𝘦𝘷𝘦𝘳𝘦 𝘢𝘤𝘶𝘵𝘦 𝘳𝘦𝘴𝘱𝘪𝘳𝘢𝘵𝘰𝘳𝘺 𝘴𝘺𝘯𝘥𝘳𝘰𝘮𝘦 𝘤𝘰𝘳𝘰𝘯𝘢𝘷𝘪𝘳𝘶𝘴 𝟸
Es decir, puedes tener la infección pero no desarrollar la enfermedad.
Esto es importante para entender la clasificación los @NIH para la infección por #SARSCoV2:
1.- Asintomático
2.- Cuadro leve
3.- Cuadro moderado
4.- Cuadro severo
5.- Cuadro criticó
covid19treatmentguidelines.nih.gov/whats-new/
Esto es importante para entender la clasificación los @NIH para la infección por #SARSCoV2:
1.- Asintomático
2.- Cuadro leve
3.- Cuadro moderado
4.- Cuadro severo
5.- Cuadro criticó
covid19treatmentguidelines.nih.gov/whats-new/
🔥Voilà un thread afin de ne pas avoir à répéter tout le temps la même chose sur la recherche médicale thérapeutique pendant #COVID19 #SARS_CoV_2 #pandemic
👇👇
👇👇
1/ Les infectiologues cliniciens n'attendaient pas de ttt antiviral permettant une amélioration "spectaculaire" pr une maladie aiguë virale sévère (cf dengue, zika, chik, grippe), il était donc nécessaire d’évaluer rigoureusement et d’espérer un ttt un peu efficace et non toxique
2/ Il existe de nombreux candidats repositionnés qui ont été utilisés et testés et ce dès le début de la pandémie : #lopinavir/#ritonavir, #remdesivir, #hydroxychloroquine, #interferon ß pour n’en citer que quelques-uns
1/
Should we use #Lopinavir-ritonavir (LPV/r) + #Ribavirin (RBV) +/- #Interferon beta-1b (IFN) to treat #SARSCoV2 #COVID19? Let’s take a look at the data.
Here’s: #HowIReadThisPaper on @TheLancet trial of triple therapy for COVID19
Hung et al: thelancet.com/journals/lance…
Should we use #Lopinavir-ritonavir (LPV/r) + #Ribavirin (RBV) +/- #Interferon beta-1b (IFN) to treat #SARSCoV2 #COVID19? Let’s take a look at the data.
Here’s: #HowIReadThisPaper on @TheLancet trial of triple therapy for COVID19
Hung et al: thelancet.com/journals/lance…
2/
First, let’s assess our baseline beliefs about triple therapy:
Before reading this study, when considering triple therapy as a treatment for patients with COVID19, I think the most important component is likely to be:
First, let’s assess our baseline beliefs about triple therapy:
Before reading this study, when considering triple therapy as a treatment for patients with COVID19, I think the most important component is likely to be:
3/
Background: A 2003 case series suggested ↓mortality (vs historical controls) in SARS patients treated with LPV/r + RBV :
ncbi.nlm.nih.gov/pmc/articles/P…
In 2015, LPV/r and IFN led to ↓viral load and improved clinical outcomes in animal models of MERS:
pubmed.ncbi.nlm.nih.gov/26198719/
Background: A 2003 case series suggested ↓mortality (vs historical controls) in SARS patients treated with LPV/r + RBV :
ncbi.nlm.nih.gov/pmc/articles/P…
In 2015, LPV/r and IFN led to ↓viral load and improved clinical outcomes in animal models of MERS:
pubmed.ncbi.nlm.nih.gov/26198719/
21/ #ZelenkoProtocol
1. Abstract Conclusion = Zinc helps
2. But: Paragraph 2 under METHODS
3. Essential to read study's methods
"Patients were *included* if ... had either been discharged from the hospital, transitioned to hospice or expired"
Full PDF:
drive.google.com/file/d/1XkIHqV…
1. Abstract Conclusion = Zinc helps
2. But: Paragraph 2 under METHODS
3. Essential to read study's methods
"Patients were *included* if ... had either been discharged from the hospital, transitioned to hospice or expired"
Full PDF:
drive.google.com/file/d/1XkIHqV…
22/ #Hydroxychloroquine & #Chloroquine & #Azithromycin
Norwegian Medicines Agency published a Warning April 23 & updated it on May 6.
Translates perfectly to English:
bit.ly/3fBSN5b
Citations:
medrxiv.org/content/10.110…
medrxiv.org/content/10.110…
#TrumpLiesAmericansDie
Norwegian Medicines Agency published a Warning April 23 & updated it on May 6.
Translates perfectly to English:
bit.ly/3fBSN5b
Citations:
medrxiv.org/content/10.110…
medrxiv.org/content/10.110…
#TrumpLiesAmericansDie
23/ #Remdesivir & #Vaccines & #SARSCoV2 & #COVID19
Norwegian Medicines Agency reports:
"Investigations started in Europe"
EMA - Remdesivir:
ema.europa.eu/en/news/ema-st…
NMA - Medicines & Vaccines:
legemiddelverket.no/english/covid-…
#TrumpPressConf #TrumpLiesAmericansDie
Norwegian Medicines Agency reports:
"Investigations started in Europe"
EMA - Remdesivir:
ema.europa.eu/en/news/ema-st…
NMA - Medicines & Vaccines:
legemiddelverket.no/english/covid-…
#TrumpPressConf #TrumpLiesAmericansDie
1/ Little Thread about all The Misleading Medical Information still floating around about #Hydroxychloroquine & #Chloroquine & #Azithromycin & #ZelenkoProtocol - by 1 doctor - @zev_dr & #Remdesivir & more
Despite #TrumpIsNotADoctor has stopped saying "What do you have to lose?".
Despite #TrumpIsNotADoctor has stopped saying "What do you have to lose?".
2/ #TrumpIsTheWORSTPresidentEVER
First, why it has been political all the way, suspected from day one:
"Trump had been touting HCQ for weeks, sparking worldwide shortages of HCQ & prompting negotiations with Indian PM Modi to lift export restrictions"
vanityfair.com/news/2020/04/i…
First, why it has been political all the way, suspected from day one:
"Trump had been touting HCQ for weeks, sparking worldwide shortages of HCQ & prompting negotiations with Indian PM Modi to lift export restrictions"
vanityfair.com/news/2020/04/i…
3/ #Trump2020
Indian PM Modi and Trump held a rally together.
"Mr Trump wanted to show people in the US that he was hugely popular abroad and that he was capable of negotiating good deals out of a country he once described as the king of tariffs"
bbc.com/news/world-sou…
Indian PM Modi and Trump held a rally together.
"Mr Trump wanted to show people in the US that he was hugely popular abroad and that he was capable of negotiating good deals out of a country he once described as the king of tariffs"
bbc.com/news/world-sou…
What evidence has the @JHSPH_NCRC reviewed to date on treatments for COVID-19? 💊💉🩸
From Gautret et al. in International Journal of Antimicrobial Agents:
Viral shedding appeared lower in the #hydroxychloroquine arm; however, important differences between groups may also explain the effect seen. bit.ly/2W5meov
Viral shedding appeared lower in the #hydroxychloroquine arm; however, important differences between groups may also explain the effect seen. bit.ly/2W5meov
From Gautret et al. in International Journal of Antimicrobial Agents:
The study did not formally assess clinical endpoints, and it is unclear whether there is #COVID19 clinical benefit with #hydroxychloroquine treatment. bit.ly/2W5meov
The study did not formally assess clinical endpoints, and it is unclear whether there is #COVID19 clinical benefit with #hydroxychloroquine treatment. bit.ly/2W5meov
1/
Should we use #lopinavir-ritonavir (LPV/r) to treat #COVID19 #SARSCoV2? Let’s take a look at the data.
Here’s: #HowIReadThisPaper on the @NEJM trial of LPV/r for COVID19 in humans: LOTUS China
Cao et al: nejm.org/doi/full/10.10…
(Thread)
Should we use #lopinavir-ritonavir (LPV/r) to treat #COVID19 #SARSCoV2? Let’s take a look at the data.
Here’s: #HowIReadThisPaper on the @NEJM trial of LPV/r for COVID19 in humans: LOTUS China
Cao et al: nejm.org/doi/full/10.10…
(Thread)
2/
Background: Lopinavir, an HIV protease inhibitor, is active in vitro against SARS-CoV and in animal models of MERS-CoV. Ritonavir inhibits CYP3A and increases serum half-life of lopinavir. A 2004 uncontrolled study of LPV/r + ribavirin suggested a benefit in SARS in humans.
Background: Lopinavir, an HIV protease inhibitor, is active in vitro against SARS-CoV and in animal models of MERS-CoV. Ritonavir inhibits CYP3A and increases serum half-life of lopinavir. A 2004 uncontrolled study of LPV/r + ribavirin suggested a benefit in SARS in humans.
3/
Question: Is LPV/r safe and efficacious for shortening time to clinical improvement in patients hospitalized with #COVID19?
Date Published: 18 March 2020
Funding: Major Projects of National Science and Technology on New Drug Creation and Development
Question: Is LPV/r safe and efficacious for shortening time to clinical improvement in patients hospitalized with #COVID19?
Date Published: 18 March 2020
Funding: Major Projects of National Science and Technology on New Drug Creation and Development
Starting a series on clinical Pearls I am gathering in #COVID19 patients based on experiences of many experts
Will add as we go along
Feel free to add your own observations/experiences
#covidclinicalpearls /1
Will add as we go along
Feel free to add your own observations/experiences
#covidclinicalpearls /1
Anosmia is likely the most specific #COVID19 related symptom
30% of patients have anosmia as their 1st symptom
#covidclinicalpearls /2
30% of patients have anosmia as their 1st symptom
#covidclinicalpearls /2
Around 90% of patients have fever.
50% maybe afebrile at the time of presentation
Fever tends to be very resistant to routine measures in hospitalized patients
There is no consensus that NSAIDs are to be avoided in #COVID2019 patients
#covidclinicalpearls /3
50% maybe afebrile at the time of presentation
Fever tends to be very resistant to routine measures in hospitalized patients
There is no consensus that NSAIDs are to be avoided in #COVID2019 patients
#covidclinicalpearls /3
1er essai clinique #COVID19 pour les antiviraux #Lopinavir-Ritonavir (inhibiteur de protéase) : PAS DE BENEFICE
Pas de différence pour le délai d'amélioration clinique
Délai médian d'amélioration clinique :
Contrôle = 16j
Lopinavir = 16j
RR=1.31 [0.95-1.85]
#COVID2019france
Pas de différence pour le délai d'amélioration clinique
Délai médian d'amélioration clinique :
Contrôle = 16j
Lopinavir = 16j
RR=1.31 [0.95-1.85]
#COVID2019france
En analyse en intention de traiter modifiée, le lopinavir – #ritonavir a conduit à un délai médian d'amélioration clinique inférieur d'un jour à celui observé avec les soins standard
La mortalité à 28 jours était similaire des les 2 groupes (19,2% contre 25,0%)
La mortalité à 28 jours était similaire des les 2 groupes (19,2% contre 25,0%)
Les événements indésirables gastro-intestinaux étaient plus fréquents dans le groupe lopinavir – ritonavir, mais les événements indésirables graves étaient plus fréquents dans le groupe soins standard
There is no proven effective antiviral drug for the treatment of #SARSCoV2
Several compounds are suggested for Rx of #COVID19. Based on the available in vitro and clinical data, which one is your preferred Rx, if available? #MayoIDQ references follow...
Several compounds are suggested for Rx of #COVID19. Based on the available in vitro and clinical data, which one is your preferred Rx, if available? #MayoIDQ references follow...
1/
#Chloroquine
Anti-malaria
Several potential mechanisms: change in cell membrane pH, impairs viral fusion, interferes with glycosylation of viral proteins
#chloroquine and #redemsivir are active against SARS-COV2 in experimental models
doi.org/10.1038/s41422…
#Chloroquine
Anti-malaria
Several potential mechanisms: change in cell membrane pH, impairs viral fusion, interferes with glycosylation of viral proteins
#chloroquine and #redemsivir are active against SARS-COV2 in experimental models
doi.org/10.1038/s41422…
2/
#Hydroxychloroquine
- Analogue of chloroquine
- Anti inflammatory effect
Hydroxychloroquine was more potent than chloroquine against #SARS-CoV2 in vitro.
doi.org/10.1093/cid/ci…
#Hydroxychloroquine
- Analogue of chloroquine
- Anti inflammatory effect
Hydroxychloroquine was more potent than chloroquine against #SARS-CoV2 in vitro.
doi.org/10.1093/cid/ci…
