Tabulated the topline results released by the #recoverytrial team on #hydroxychloroquine & #dexamethasone, and went over their protocol (recoverytrial.net/results) to better digest them.
Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Important point from #RECOVERYTrial protocol
- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
So if a patient enrolled in #recoverytrial had a contraindication to #dexamethasone, that patient was not allowed to be randomized to that arm. So the results need to be interpreted in the context of no contraindication to steroids: already on steroids, #immunosuppression, etc.
Also important that although 6mg of #dexamethasone is the #glucocorticoid mentioned in the release and in the protocol initially, doctors could give equivalent doses of other #steroids: 40mg of #prednisolone, 80mg of #hydrocortisone, others
For all was up to 10 day intervention
For all was up to 10 day intervention
The endpoint in the #RECOVERYTrial is #mortality by day 28, which is great, not using the #WHO ordinal scale. This is different than the #remdesivir trial results thus far, which have reported day 14 or day 11 outcomes based on the scale. I'm waiting for those day 28 results too!
on June 6, we found the overall mortality for usual care in the #RECOVERYTrial was ~24% based on 3132 patients. today we get information by respiratory status at randomization with an overall n=4321, but unknown N per group
- 41% if on the venti
- 25% if on O2
- 13% if room air
- 41% if on the venti
- 25% if on O2
- 13% if room air
How does that 28-day mortality compare with US centers and other countries?
Important detail is that randomization in the #recoverytrial was not stratified by respiratory status, but should not be an issue with >11000 randomized, but a potential weakness.
Important detail is that randomization in the #recoverytrial was not stratified by respiratory status, but should not be an issue with >11000 randomized, but a potential weakness.
Putting the #RECOVERYTrial #dexamethasone arm & #remdesivir results to date, some interesting contrasts
- DEX helped the most where RDV had little impact, those on mechanical ventilation
- RDV helped consistently those for whom DEX was unhelpful, RR>1, those on room air
- DEX helped the most where RDV had little impact, those on mechanical ventilation
- RDV helped consistently those for whom DEX was unhelpful, RR>1, those on room air
And those with supplemental oxygen benefited the most on the #remdesivir trials, and got helped also by short course of #dexamethasone.
Will be this obvious interaction be #synergistic, additive, or antagonistic when used together. A good question for #ACTT and #RECOVERYTrial!
Will be this obvious interaction be #synergistic, additive, or antagonistic when used together. A good question for #ACTT and #RECOVERYTrial!
Just to remember that usual care is a lot of #care in an intensive care unit anywhere in the world: patients need to survive The Valley of Nosocomiality: ventilator associated pneumonias, thromboembolic disease, catheter associated infections, etc.
Ready to do this, but my preference for #COVID19 is to take the fight outside of the #hospital with earlier interventions that minimize need for hospitalization and their consequences: outpatient #antiviral trials, preventive #monoclonals, etc, while #vaccines make their way.
