Thread by @GaetanBurgio

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

https://twitter.com/GaetanBurgio/status/1253482717334794241

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

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

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

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

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