this study looks important:

it was controlled, prospective study. it's showing a stunning 71% mortality benefit in moderate to severe covid-19 cases even in the very old.

remdesivir shows no morality benefit.

baricitinib is a widely available RA drug available in pill form.
601 patients in the trial at university of pisa and albacete hospital.

83 treated with baricitinib. 83 controls established at same time using propensity score matching.

patients also received standard of care medication.
this led to dramatic differences in outcomes.

composite endpoint of death or mechanical ventilation was 29 in control group (34.9%) vs 14 in active arm (16.9%). 52% reduction. p<0.001.

effects were rapid and sustained.

curve separation was almost instant.
and active arms and controls were well matched both on risk factors, age, and other care received.
what's really striking is how efficacious this was even in the very old and sick.

avg age in the albacete group was 80.9 (baricitinib) and 80.6 (control)

that group has had very little in the way of successful treatment options

death or IMV was 9 in drug, 16 in control. p<0.01
MCRA for primary outcome has drug at p =0.0001.

that is an insanely good number for such a small trial.

i read 1000's of drug trials. this is vanishingly rare.

i'd take this very seriously as an option even on just one trial.
further, in prato hospital:

drug: 0% of patients in ICU 2 weeks after treatment, 78% discharged.

control: 33% of patients in ICU, 6% discharged

p = 0.01, <0.0001 respectively

also had huge effects on key variables

97 vs 92 SpO2 is huge effect. 97 is "normal" <94 = hypoxic
all in all, this looks like a sound, prospective study design with well matched control.

it shows large and near instant separation in curves and major mortality, ventilation, and ICU benefit even in the very old who have been so vulnerable to covid.

this looks VERY promising.
and it blows remdesivir out of the water, esp for the very sick.

gilead rammed remdesivir through and the NIH panel let them change their primary endpoint right before read out to save the trial from failing.

it has no survival benefit and never did.

medpagetoday.com/infectiousdise…
i'm sure this had nothing to do with the 8 people on the NIH panel that oversaw the trial that are paid by gilead...
71% mortality benefit and 52% drop in death/ventilation composite in an age group this vulnerable is worlds better than any other treatment i have seen here and, unlike so many, the trial looks valid.

you can read the whole paper here.

advances.sciencemag.org/content/advanc…
please share this. if this confirms/plays out as described, it could be a major step forward in care and in reducing deaths among the most vulnerable.

would love to get some more takes on this data.
the only real hole i can see here might be that the study was not randomized.

83 were selected for active arm and then 83 were matched. so it was prospective and the matching looks good unless there is some non-identified characteristic that led to initial active arm selection.
there is no obvious factor jumping out at me there, but that does not mean that such a factor could not or does not exist.

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with el gato malo

el gato malo Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @boriquagato

17 Nov
it staggers me that we're still having this argument.

the truth is utterly simple and perfectly clear:

anyone who still speaks of "cases" as "proven" by a positive PCR test at 40Ct (or even 30) is either virologically illiterate or seeking to mislead you

these are not cases.
these PCR tests are NOT suited to purpose

they are a preposterously over sensitive assay. w/ a sensitive enough detector, i can find traces of bacon in your kitchen from breakfast 2 yrs ago

this does not mean you have bacon contamination

it means you're using a stupid measure
this is why NONE of the vaccine trials accept this definition of "covid case." all require symptomatic conformation as well.

mass testing is NOT the cure to an epidemic. it's the progenitor of a fake one.

we've made this mistake before

Read 10 tweets
16 Nov
the great reset is not new in any way, shape, or form. it's just a critical race theory rehash of the club of rome policies with a better powerpoint deck.

mussolini cold have easily written it if someone had taught him the word "stakeholder".

it's classic fascism.
wilson would have recognized and applauded it instantly.

you get government, media, and big business all aligned to shape the economic, social, and moral spheres of the society from the top down "for its own good."

(pro tip: this never works out for "we the people")
this sort of dictatorial control is the seductive trap that smart people fall for.

"i'm smart so everyone would be better off if they all just did what i said" is some seriously powerful kool-aid to get drunk on.

always has been.
Read 11 tweets
15 Nov
on friday, governor wanda "lockdown" vazquez announced a tightening of puerto rico's restrictions and a whole set of "BEHAVE OR WE'LL MAKE IT WORSE!" threats.

among them:

• The National Guard has been activated to enforce EO compliance.

photo from VSJ promenade this morning:
let's hope this is just an unfortunate coincidence, but when you hear this kind of absolutist talk that puts systems over people, well, it's not hard to imagine the sound of jackboots

“We will not under any circumstance allow our health system to be placed at risk,” she said
“If during this new order that ends on December 11, we do not see a response from citizens and businesses in compliance, we would have to take more severe measures. I trust that those who are not complying will reconsider ” , Vázquez warned.

("cackled gleefully" is more like it)
Read 5 tweets
14 Nov
this is literal nonsense and propaganda.

it's also very possibly medical malpractice.

the idea that a patient healthy enough to tell you this needs to be intubated is ridiculous.

this "vent early, vent hard" strategy was a massive killer of patients.

it's disastrously wrong.
i do not know who this nurse is, but she's a liar or a fool. probably both. the move from early, aggressive venting to proning and O2 has saved an enormous number of lives.

was just talking about this the other day.

but this is NOT new news.

certain internet felines (and a great many of the smart physicians) had figured this out back in april.

this is not a perfect measure, but it's close enough and bolstered by reports from many physicians to whom i've spoken.

Read 8 tweets
13 Nov
@elonmusk you cannot quite think about it that way.

you need to consider specificity of the test (what % of true neg will test pos) but that will not give you false pos without knowing prevalence.

98% specificity at 2% prevalence = 50% of positives are false.

@4%, only 1.3 are false
@elonmusk @4 this then runs into further complexity when you consider PCR artifacts.

we run the US as 40 Ct. anything over about 30 is non-clinical. so out test is 1000x too sensitive.

so false + rises (clinically) as there is a bigger tail of recovered.

@elonmusk @4 this makes for a total mess of cross variables.

add in the rapid tests which are antigen, not pathogen and can catch disease from even back i march, and the + rate really gets out of hand.

it's not a coincidence that %+ is spiking since that test rolled out.
Read 5 tweets
13 Nov
as part of the new exec order once more cranking down on puerto rico is this little gem:

not only must every restaurant post its capacity (at 30% of normal) but the poster must have the number to dial to report non-compliance.

fascism works best when you do the work for them.
this is the sort of "karen-oia" that gets used to divide a people and make them fearful of one another as well as the state

it's an old trick from authoritarian communist/fascist regimes

then, of course, the obligatory threats:

the beatings will continue until morale improves!
as ever, there is zero science to it, just nonsense.

we were at 50% open, then 55% (yes, really), now 30%

but hey, now we can't go to the beach anymore (again) except for "individual sports"

no fresh air for you! stay inside where covid spreads better

what. utter. muppets.
Read 4 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!