1/ Awesome 🤩: RCTs coming out answering important questions on Covid19!

A trial designed/coordinated by 🇧🇷 trialists @RenatoDLopes1 @damiani_petri Pedro Barros

DSMB chaired by Alexandre Biasi, who I luckily can call a friend

thread:

jamanetwork.com/journals/jama/… @JAMA_current Image
2/ Why this trial was needed? 🧐

ACE2 is the receptor for SARS-CoV-2

Select preclinical investigations have shown upregulation of ACE2 by RAAS inhibitors (such as ACEIs and ARBs), raising concerns about their safety in patients with COVID-19

science.sciencemag.org/content/367/64… Image
3/ A multicenter open-label RCT with blinded end-point assessment was performed:

POPULATION: 659 pts hospitalized with COVID-19 who were taking ACEIs or ARBs prior to hospital admission (mild and moderate Covid19)

INTERVENTION: discontinuation vs continuation RAAS inhibitors
4/
PS: For patients randomized to the discontinuation group, other drugs could replace the RAAS inhibitors at the discretion of the treating physician.
β-Blockers for HF were maintained

OUTCOME: Days Alive and Out of the Hospital ImageImage
5/
1ary outcome effect consistent across major predefined subgroups (age, obesity, ACEI vs ARB)

BUT, there was a significant interaction with the results slightly favoring the group continuing ACEI or ARB therapy among patients with lower SpO2 and ⬆️baseline disease severity Image
6/ Some important baseline characteristics of the trial pop (in order for you to access external validity):

All pts Sp02 < 94% in room air
Mean age ~55 (around 15% older than 70)
BMI ~30
100% Hypertension
VERY small proportion of HF or CKD
7/ Important message: it is REASSURING to keep patients on ACEi/ARB when admitted to the hospital due to Covid19

Congrats to everyone involved!
FYI: between trial design and result presentation at the late break Cardiology European Congress = 5 months 😱 #CovidTimes

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More from @leticiakawano

21 Jan
1/ Our study is out on the @bmj_latest 🤩

TOCILIZUMAB added to the standard of care did not improve clinical outcomes in hospitalized pts with severe Covid19

Let me walk you through the results Image
2/ Baseline characteristics: ~57yo, around 1/2 of the patients on low flow O2, ~15% on IMV; 20-40% on NIV/HF (random imbalance between groups)

70% of the patients were using steroids at baseline

These pts had high CRP (higher in the control), high LDH, high ferritin: ImageImageImage
3/ Even though, at baseline, the control group seemed to have more severe cases than TOC group (> n. of pts on NIV/HF), the proportion of deaths was higher among TOC group from 8 days of FUP on.

PS: ⬆️ death but no ⬆️ IMV 🤔

Death causes: ARF or multiorgan system failure Image
Read 6 tweets
20 Jan
1/Hoje lembrei de vocês aqui, cientistas de dados:

Tentando entender o endurecimento das medidas restritivas em Paris 🤔 quando "estamos tão bem há semanas", descobri que a decisão foi tomada com base na vigilância genômica da variante B117 e Image
2/ na tendência de ⬆️ no n. de casos novos.

Antecipa-se que, por conta da B117, via modelagem matemática, é possível que a França precise de um 3o confinamento em breve 😐

Sonhando com o dia em que nossos cientistas serão igualmente ouvidos no Brasil. #Quediferenca
Read 4 tweets
17 Jan
1/ Covid19 is out of control in 🇧🇷 creating chaos & avoidable deaths.

This is the DIRECT result of a political agenda led by the Brazilian Federal Government.

I will provide evidence to help @ministerpublico @STF_oficial @camaradeputados @SenadoFederal do its job. Thread:
2/ Early at the beginning of the pandemic, the world knew very little about Covid

It is understandable that, at that time, wrong guidance was temporarily issued to the pop...

The important thing was that these GUIDANCES WERE UPDATED AS WE LEARNED MORE...
3/ By January 2021, it is CONSENSUS among the international scientific community that HYDROXICHLOROQUINE has *no* place in the management of Covid19:

WHO: bmj.com/content/370/bm…

NIH: covid19treatmentguidelines.nih.gov

CDC: cdc.gov/coronavirus/20…

In Brazil, various Medical Societies...
Read 15 tweets
14 Jan
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: Image
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 😱

Stop this madness!
@ministerpublico @STF_oficial @SenadoFederal @camaradeputados
@RodrigoMaia
Read 4 tweets
18 Nov 20
1/ *tweetorial* on how to participate in #ATSchats

Helloooo #Medtwitter , #PCCSM people, and everyone else interested in participating in the #ATSchat s: this 🧵 is for you!

If it's your first time and you don't know how to do it, follow me ;-) @atsearlycareer @atscommunity
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!

(see screenshot below)
@SushmaCribbs
3/ @ATSearlycareer will post the questions starting with Q1, Q2, Q3, and so on.

You can answer the question in one of two ways:

a. Below is one way (see screenshot): type in #ATSchat and A1, A2 respectively and answer it ;-)
Read 9 tweets
5 Sep 20
1/ Another result of the collaborative effort, Coalition Covid-19 Brazil, is out!
Kudos at this time to HIAE trial coordination: Otavio Berwanger & Remo Furtado, not on twitter 😕 @JuliaMachline #COVIDー19 @TheLancet @f_g_zampieri @a_serpaneto @FlaviaSepsis @azevedo_lcp
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)
Read 6 tweets

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