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Lots of discussion of the wide confidence intervals in this trial & post hoc finding that early initiation might be ok; how to interpret?

Also, lots of enthusiasm for hydroxychlorquine, remdesivir

My take on antiviral drugs #COVID19 & why Anthony Fauci agrees (quote) [thread]
First, its easy to think about HCV drugs and HIV protease inhibitors and think all anti-viral drugs are great.

However, if you zoom out, 30000 ft view, and consider all anti-viral drugs ever thought to be promising, you would see things differently
Hundreds, thousands of candidate compounds have failed.
Making useful antiviral drugs is not easy.
Many common virus still have suboptimal therapies (CMV, HSV1/2).
Our approved drugs are often marginal.
Second, laboratory evidence of activity or promise means very very little.

As is often the case in medicine, while it is nice to see in-vitro evidence of antiviral activity, that is nothing to hang your hat on.
Third, for patients stricken with COVID19 and not improving or worsening, it is human nature to try something. It is an understandable human reaction.

Even if the evidence is weak or lousy, what do we have to lose?
Fourth, what you have to lose is the opportunity to know what actually helps vs. what hurts.

Already there are many reports of folks being treated with kitchen-sink approaches. Tamiflu, Kaletra, Steroids, chinese herbal medicines, antioxidants. All together, all at once
Fifth, others are doing uncontrolled studies & hyping them
(not very useful in a condition where many but not all pts improve)

Worse, many trials measure unproven surrogates such as viral measurements based on swabs.
No one knows how to interpret these endpoints
Sixth, enter current study; is the CI so wide the true benefit or risk remains uncertain

Yes, certainly
But, what does that mean?
Should we continue the ongoing Kaletra studies and pool the results? yes!

We should use off protocol? -
Sadly, that's how we got in this mess

And the pretest prob any of these drugs help is probably v. v. low, sadly
That's why I take the same view as St. Anthony of Fauci that giving drugs based on these data off-protocol is a disservice.

Read it in his own words...
The most important studies to do are RCT of drug vs. placebo in severe COVID with the primary endpoint of 30 day mortality;

Some similar trials are ongoing.
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