Two results came out today on Remdesivir treatment for #COVID19 infection.

The first one is a double blind controlled multi center clinical trial on 237 patients in China

The second one 5 versus 10 days treatment in severe #COVID19 patients

Let's have a look -> thread
The first study is a double blind placebo controlled multi center clinical trial in China in 237 #COVID19 patients. We have now the published result of this trial. Please remember there was a leak on this trial a week ago

158 remdesivi treatment placebo group 79 not 1:1 randomized

incl criteria > 18 y/o #SARSCoV2 + Sao2<94% pneumonia

excl criteria: pregnancy, liver enzymes high...

regimen 200 mg day 1 + 100 mg on days 2–10 IV 1x/day

outcome: clinical improvement aka discharge or ICU admission Image
Results. Not much difference between the 2 group. In fact results were identical between group for clinical improvement, mortality at day 28, viral load very much no differences at all.

In short no efficacy for remdesivir in this small group of #COVID19 patients ImageImage
The paper has been published in @TheLancet today but unfortunately under #paywall and I don't know why. It should be one access in my view

thelancet.com/journals/lance…
So now that announcement from the @NIH today. This is again a phase 3 randomized double blind controlled clinical trial. This is the american arm of the large ramdesivir trial. This is a press release and there are very little details

niaid.nih.gov/news-events/ni…
@NIH All we know is the time to recovery is significantly lower in #remdesivir group (11 days) versus placebo (15 days) and mortality rate is lower in remdesivir group (8%) vs placebo (11%)

In my view the difference in outcome seems rather modest but more details to come soon Image
Next the last study, this time Gilead released the results in their press release. This is a 5 day versus 10 days open label treatment in a cohort of 397 patients. No controls included.

gilead.com/news-and-press…
They found no differences in outcome between #remdesivir 5 days versus 10 days treatment and >50% of the patients were discharged at day 14 but I don't know what all of this means without a control group. All it says is no ≠ in outcome on 5d vs 10 d treatment. That's all ImageImage
In short

Remdesivir might improve clinical outcome in severe #COVID19 patients but in my view clearly not a silver bullet

More details are needed from the @NIH trial. Beware the overhype

I am concerned that many Remdesivir trials don't have a control group.Waste of resources

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More from @GaetanBurgio

Apr 18, 2020
Another study on #Hydroxycloroquine efficacy in #COVID19 patients from a Brazilian team has been shared widely this evening. Unfortunately I have to comment it because well it might have some public health implication & this study is atrocious

dropbox.com/s/5qm58cd4fnee…
This study is not a clinical trial but a cohort study on 721 patients, recruited by telemedicine. Incl criteria Flu symptoms, OK to be treated > 18 y/o. Probable diagnosis of #SARSCoV2 but RT-PCR or X ray not compulsory. We don't even know if those patients had #COVID19 😳 😡🤦‍♂️
Outcome -> hospitalisation at day 7, that's it.

721 patients unrolled. 85 not followed -> 636 left => 225 refused treatment -> control group 😳 & 412 patients Hydroxycholoquine + azithromycine (dose unknown)
All followed daily by telemedicine consultation => huge select biais Image
Read 9 tweets
Apr 10, 2020
A question I often get. Why Lupus patients that have taken Hydroxychloroquine for years have no side effects whereas severe adverse cardiac side effects are described #COVID19 patients under hydroxychloroquine treatment? Let's have a closer look
Let's start with #COVID19. Does #COVID19 causes cardiac effects? The answer is yes from 2 published surveys from Wuhan hospitals. First one reports on 416 hospitalized patients -> 19.7% with myocardial injury + ⬆️cardiac troponin & high mortality rate 51% jamanetwork.com/journals/jamac… Image
The second paper shows similar observation on 187 hospitalized patients -> 27% had cardiac injury with again elevation of cardiac troponin and increase mortality rate at 59%. In short #COVID19 leads to significant cardiac injury but these are severe cases jamanetwork.com/journals/jamac… Image
Read 13 tweets

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