1/ Colleagues from Manaus reaching out in complete distress:
Covid19 patients that were *improving* are experiencing extreme anguish/panic while dying due to lack of Oxygen!
A system does not colapse out of the blue!
Avoidable catastrophe:
2/ NO BEHAVIORAL MEASURE to stop Covid19 was implemented in Manaus (nor anywhere else) in the last 4 weeks.
The population is left to its own luck (or lack of)
The President keeps disencouraging face masks, social distancing, and, BELIEVE ME, vaccination!
3/ If this was not enough, his proposal to address the Covid19 crisis in Brazil is early treatment with hydroxycholoquine, ivermectin, nitazoxanide 😱
2/ At the scheduled date/time:
1.Type #ATSchat in the search bar at the top right of your window.
2.Ensure you click on the “latest” tab: This allows the chronologically most recent tweets to show up allowing you to easily follow the chat!
2/ Here the population included in the trial, note that about half of pts were on IMV, ~1/4 shocked. Steroids were being administered to only 15-20% (at that time, early on in the pandemic, steroids were not known to benefit severe covid-19 pts)
3/ At day 15, the use of azythromycin 500mg/d for 19 days did not change health status, look at death (6) and IMV (5) or discharged pts (1)
1/ It's out! The Codex trial.
This is the 2nd RCT result published as a result of an unprecedented collaborative research effort, the Coalition Covid19 Brazil 🇧🇷.
Deserve special recognition: @azevedo_lcp@ICURevisited and all HSL team!
2/ In the Codex trial, mod-severe Covid-19 ARDS cases were randomized to Dexa 20mg/d for 5 days followed by 10mg/d for more 5 days.
*Dexa increased the number of days alive & free of mechanical ventilation in 28 days*
PS: for MV-free days, death was penalized as 0 free days
3/ When you breakdown the composite 1ary outcome in its components, note that mortality was the major driver of difference between groups. No short-term difference in AE was noted:
2/ Back in March, we knew much less than we know today on Covid19 (and as a consequence v. little information to inform RCT design)
Regulatory agencies & WHO have defined the ordinal scale as an important outcome.
As @f_g_zampieri commented (in Portuguese) elsewhere
3/ We realized, after the trial started, that a clinical status ordinal scale would be potentially problematic given that the level of support offered could differ between countries and local practices not reflecting necessarily dz severity
1/ Our study (Coalition I) on HCQ and azithromycin for #Covid19 is out!
This study is the effort of an unprecedented collaboration (Coalition Covid19 Brasil) established between major Brazilian hospitals and research networks/Institutes.
2/ Coalition I is one of nine RCTs on drug repurposing and long-term consequences of Covid19 being conducted by this research team.
I am honored and humbled to be part of this research effort in Brazil in such daring times.
3/ 667 hospitalized pts w mild to moderate Covid19 (pts on NIV/HF or MV were non-eligible) were randomized 1:1:1 to:
-HCQ + Azithromycin + Standard of care* (SoC)
-HCQ + SoC
-SoC
*SoC: antibiotics (~60%), oseltamivir (~25%), and steroids (~20%) w/o difference between groups.