Discover and read the best of Twitter Threads about #actt1
Most recents (6)
Updated WHO severe COVID treatment guidelines bit.ly/3rhGgKW
Recommended
🟢Steroid (#Dexamethasone)
🟢IL6 blocker (#Toci) or 🟢JAKi (#Baricitinib)
🟠±mAb in seronegative people
NOT recommended
🔴#Hydroxychloroquine
🔴#ivermectin
🔴#remdesivir
Lots to discuss, a🧵
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Recommended
🟢Steroid (#Dexamethasone)
🟢IL6 blocker (#Toci) or 🟢JAKi (#Baricitinib)
🟠±mAb in seronegative people
NOT recommended
🔴#Hydroxychloroquine
🔴#ivermectin
🔴#remdesivir
Lots to discuss, a🧵
1/
Remdesivir (RDV) is in the “We suggest no remdesivir” category.
At some level, this isn’t too surprising & is old news.
Despite initial hype, RDV never moved the needle much on patient centered outcomes (risk of mortality or requiring IMV) & many of us had stopped using it.
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At some level, this isn’t too surprising & is old news.
Despite initial hype, RDV never moved the needle much on patient centered outcomes (risk of mortality or requiring IMV) & many of us had stopped using it.
2/
In #ACTT1 RDV did improve outcomes on an ordinal scale, but the effect was modest. It shortened time to clinical improvement but not hospital LOS (patients stayed in the hospital longer to receive it).
RDV did NOT improve mortality or risk of IMV.
ncbi.nlm.nih.gov/pubmed/32445440
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RDV did NOT improve mortality or risk of IMV.
ncbi.nlm.nih.gov/pubmed/32445440
3/
It took a while to digest the details of over 600 pages, but here is my review and comparative analysis of the #ACTT2 trial that compared #baricitinib vs. #placebo among patients receiving #remdesivir for #COVID19!
Some very interesting insights, I think!
Sit briefly and enjoy!
Some very interesting insights, I think!
Sit briefly and enjoy!
Will be mainly comparing #ACTT2 to #ACTT1, but also will get some insights and questions that come up when comparing #ACTT2 to the #dexamethasone #RecoveryTrial
The idea of using #baricitinib (aka Bari) for #COVID19 is in this commentary in .@TheLancet from Feb. when Peter Richardson & Co working .@benevolent_ai .@ucl searched drugs and noted that #bari could block inflammation & viral endocytosis.
link: thelancet.com/journals/lance…
link: thelancet.com/journals/lance…
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
Time to share some thoughts and questions following the .@medrxivpreprint first release of results from the #SolidarityTrial that compared local standard care to #remdesivir, #HydroxyChloroquine #lopinavir_ritonavir and #interferon for treatment of patients with #COVID19
I have read the #solidarityTrial preprint: medrxiv.org/content/10.110…
Its supplementary material:medrxiv.org/content/10.110…
its posted protocol: who.int/publications/m…
The CRF: who.int/publications/i…
The final report from #ACTT1 for contrast: nejm.org/doi/full/10.10…
Its supplementary material:medrxiv.org/content/10.110…
its posted protocol: who.int/publications/m…
The CRF: who.int/publications/i…
The final report from #ACTT1 for contrast: nejm.org/doi/full/10.10…
Everyone has focused on the results, which is understandable, yet understanding the specifics in #SolidarityTrial design compared to the #ACTT1 design, may bring light into the differences reported between trials and may give a way to do better in #COVID19 #therapeutics
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.
Updated the #RECOVERYtrial topline results summary table of the #dexamethasone arm compared to usual care for treatment of hospitalized patients with #COVID19.
Got additional information colleagues shared in Twitter.
Thread with some comparisons with #ACTT1
#IDtwitter 1/
Got additional information colleagues shared in Twitter.
Thread with some comparisons with #ACTT1
#IDtwitter 1/
the #ACTT1 authors have only reported (preliminary) Day 14 mortality, and the #RECOVERYtrial has only posted Day 28 mortality.
But these days the Supplementary Appendices in trial reports have additional relevant information:
nejm.org/doi/full/10.10…
#DontCoverDiscover
But these days the Supplementary Appendices in trial reports have additional relevant information:
nejm.org/doi/full/10.10…
#DontCoverDiscover
