Discover and read the best of Twitter Threads about #actt
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Posting some reflections on the #ACTT & #RECOVERY trials related to #remdesivir & #dexamethasone for the treatment of #COVID19
Those results feel like definitive advances, but we need to realize their limitations and need for confirmation despite everyone's #pandemic fatigue
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Those results feel like definitive advances, but we need to realize their limitations and need for confirmation despite everyone's #pandemic fatigue
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There are lot of skeptics in and outside of #Twitter on the results of both trials, strong emotions regarding big-pharma made medications, the way the #EUA was made, also about use of #steroids in the #ICU that has a quite rocky history among those who run those units.
And we need to acknowledge from the outset all sorts of basic, and not so basic, emotions that come in the doing clinical trials, exacerbated by academic cliques, national defense issues (and nationalisms) that can get exacerbated with the strains in health systems.
Tabulated the topline results released by the #recoverytrial team on #hydroxychloroquine & #dexamethasone, and went over their protocol (recoverytrial.net/results) to better digest them.
Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Important point from #RECOVERYTrial protocol
- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
So if a patient enrolled in #recoverytrial had a contraindication to #dexamethasone, that patient was not allowed to be randomized to that arm. So the results need to be interpreted in the context of no contraindication to steroids: already on steroids, #immunosuppression, etc.
#Remdesivir begins distribution in the #USA today via #EUA.
I thought would write down some practical #tips based on my #qualitative anecdotal experience after personally treating close to 200 patients with #COVID19.
For quantitative results, wait for the papers¬—thread
I thought would write down some practical #tips based on my #qualitative anecdotal experience after personally treating close to 200 patients with #COVID19.
For quantitative results, wait for the papers¬—thread
“this juice works, doc!” When you hear similar expressions 1-2 days after starting #remdesivir multiple times, you start to wonder. Don't recall a similar proportion of patients smile after feeling so sick 1-2 days earlier with #COVID19. x/n? Wait for the papers.
Like #treatment for any severe infectious disease (meningitis, Gram-negative bacteremia, influenza pneumonia, etc), earlier is always better. #COVID19 is no different. #Remdesivir stops #SARS-CoV2 replication, but won’t heal the lung injury.
Lots of colleagues & friends remain sore after the #FauciLeak on the interim #ACTT trial analysis that compared #remdesivir to placebo in patients hospitalized with severe #COVID19 2 days ago.
My thoughts on the events as a #clinicaltrials and #DSMB doctor—thread 1/10
My thoughts on the events as a #clinicaltrials and #DSMB doctor—thread 1/10
Data Safety Monitoring Boards (#DSMB) are independent groups of doctors & statisticians that analyze unblinded data in clinical trials, key to assure safety of patients enrolled, think about it as a safety satellite or control tower for the blinded investigators & patients.
