Thread by @KrutikaKuppalli

Exciting article in @NEJM on #remdesivir (Rx I had my eye on from the start, NOT #HCQ). Info below
1. Pts confirmed with #SARSCoV2 with O2 Sat < 94%
2. Received 10 days of drug (200 x 1 then 100 daily)
3. 36/53 patients (68%) had clinical improvement

nejm.org/doi/pdf/10.105…

4. 30 (57%) on mech ventilation and 4 (8%) ECMO
5. Median f/u 18 d
- 36 (68%) improvement with oxygen support
- 17/30 (57%) on mechanical vent, extubated
6. 25 pts (47%) were discharged
7. 7 pts (13%) died
8. Mortality
- (18%) (6/34) pts inv. vent
-(5%) (1/19) not w/ inv. vent

Full Breakdown of Study Below
- 61 pts received at least one dose, 8 excluded due to missing info-->53 remained
- 40 (75%) received full 10 d course
- 40 (75%) male
- Age range 23-82 yrs (median 64)
- Majority 34(64%) receiving invasive ventilation w/ median time 2d prior to rx

- Those w/ inv. vent were older, male, higher ALT, Cr, and co-existing condition (HTN, DM, Dyslipidemia, Asthma)
- 36/53 (68%) had improvement in oxygen over median of 18 d
- 8/53 (15%) did worse
- All on ambient air or low flow O2 improved
- 17/30 (57%) mech vent extubated

- 3/4 on ECMO stopped and were alive at f/u
- 7/53 (13%) died after completing remdesivir
- Median interval btwn remdesivir initiation and death was 15 days
-Risk of death was great if > 70 yo and if higher Cr at baseline
- Common AE were inc LFTs, diarrhea, rash, AKI, low BP

My Takeaway Points
- Overall this is promising data for a drug we already knew had broad anti-viral activity esp in patients who are critically ill
- Need information on viral load effect of remdesivir
- Need more info on safety of drug
- Info on the RCT will be interesting

- Another small data set of a drug used under compassionate use
- We need longer term follow-up in patients who received the drug
- We need to look at other confounders in the clinical care of the patients

Congrats to the investigators and @GileadSciences