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Francisco Marty, MD Profile picture
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25 Jan, 7 tweets, 8 min read
To cap a weekend of #colchicine-induced GI upset from the press release of #ColCorona trial relative %s approaching statistical significance for #COVID19... started getting messages regarding #Maduro's announcement this evening of #Carvativir, Jose Gregorio's miraculous drops
He plans to distribute the new wonder anti-#COVID19 treatment widely throughout #Venezuela this week. He mentioned the drug is given as drops sublingually every 4 hours...

efectococuyo.com/salud/carvativ…
The news on #Carvativir is likely to generate multiple creative responses from many, likely to compete with the #BernieMeme from the last few days.

If you look closely at the bottle, #Carvativir's active ingredient is #isotimol (#isothymol), at a concentration of 5mg/mL.
When you search for #isothymol in Pubmed, you find this link of an in-silico study postulating #isothymol may be active against #SARSCoV2 by blocking ACE2

pubmed.ncbi.nlm.nih.gov/32362217/
Then it gets more interesting when you Google #isotimol.
You find this direct connection between #Carvativir, the proposed brand name of #isothymol for treatment of #COVID19, posted online by Laboratorio Farmacológico de Venezuela.

Link:scribd.com/document/47544…
The main author is Raul Ojeda from Droguería J&R, with other authors form this local Pharma company, a doctor from one of the Caracas Public Hospitals and someone from a government agency.
The 69 slides have a colleague of #SARSCoV2 biology & experiments?

scribd.com/document/47544…
It’sclear that some people have been thinking about #isothymol.

The treatment claim for #Carvativir’s brand for #COVID19 is unsubstantiated by any clinical data, but as a #Maduro pres-release, it may hit the social media waves for another high of sublingual bread & circus.

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More from @FranciscoMarty_

Francisco Marty, MD Profile picture
21 Dec 20
It took a while to digest the details of over 600 pages, but here is my review and comparative analysis of the #ACTT2 trial that compared #baricitinib vs. #placebo among patients receiving #remdesivir for #COVID19!

Some very interesting insights, I think!

Sit briefly and enjoy!
Will be mainly comparing #ACTT2 to #ACTT1, but also will get some insights and questions that come up when comparing #ACTT2 to the #dexamethasone #RecoveryTrial
The idea of using #baricitinib (aka Bari) for #COVID19 is in this commentary in .@TheLancet from Feb. when Peter Richardson & Co working .@benevolent_ai .@ucl searched drugs and noted that #bari could block inflammation & viral endocytosis.

link: thelancet.com/journals/lance…
Read 25 tweets
Francisco Marty, MD Profile picture
9 Dec 20
With the .@NIAIDNews #ACCT1 trial final report published on 05 Nov 2020 and the .@WHO's #SolidarityTrial Preliminary report published on 02 December 2020, thought it would be good to take another look at both trials and find ways forward for the patients we are dealing with today
Motivated by a patient I am dealing with who will survive very severe #COVID19 in the setting of transplant, but her father, who was hospitalized earlier than her with moderate COVID, was left to progress and died before her discharge, given #remdesivir only after going on #BiPAP
Here is the link to the prior analysis and I think the new publications give some interesting details which will follow

Read 39 tweets
Francisco Marty, MD Profile picture
20 Oct 20
Time to share some thoughts and questions following the .@medrxivpreprint first release of results from the #SolidarityTrial that compared local standard care to #remdesivir, #HydroxyChloroquine #lopinavir_ritonavir and #interferon for treatment of patients with #COVID19
I have read the #solidarityTrial preprint: medrxiv.org/content/10.110…

Its supplementary material:medrxiv.org/content/10.110…

its posted protocol: who.int/publications/m…

The CRF: who.int/publications/i…

The final report from #ACTT1 for contrast: nejm.org/doi/full/10.10…
Everyone has focused on the results, which is understandable, yet understanding the specifics in #SolidarityTrial design compared to the #ACTT1 design, may bring light into the differences reported between trials and may give a way to do better in #COVID19 #therapeutics
Read 26 tweets
Francisco Marty, MD Profile picture
12 Aug 20
Posting some reflections on the #ACTT & #RECOVERY trials related to #remdesivir & #dexamethasone for the treatment of #COVID19

Those results feel like definitive advances, but we need to realize their limitations and need for confirmation despite everyone's #pandemic fatigue

1/ Image
There are lot of skeptics in and outside of #Twitter on the results of both trials, strong emotions regarding big-pharma made medications, the way the #EUA was made, also about use of #steroids in the #ICU that has a quite rocky history among those who run those units.
And we need to acknowledge from the outset all sorts of basic, and not so basic, emotions that come in the doing clinical trials, exacerbated by academic cliques, national defense issues (and nationalisms) that can get exacerbated with the strains in health systems. Image
Read 21 tweets
Francisco Marty, MD Profile picture
17 Jun 20
Updated the #RECOVERYtrial topline results summary table of the #dexamethasone arm compared to usual care for treatment of hospitalized patients with #COVID19.

Got additional information colleagues shared in Twitter.

Thread with some comparisons with #ACTT1

#IDtwitter 1/
the #ACTT1 authors have only reported (preliminary) Day 14 mortality, and the #RECOVERYtrial has only posted Day 28 mortality.

But these days the Supplementary Appendices in trial reports have additional relevant information:
nejm.org/doi/full/10.10…

#DontCoverDiscover
The paper says they were not reporting day 29 mortality, but If you look at Figure S3 in the #NEJM #ACTT1 preliminary report, you have KM estimates out to day 30.

From there you can visualize the probability of death at day

28 (see figure) have left lines and scales
Read 12 tweets
Francisco Marty, MD Profile picture
16 Jun 20
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—
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
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.
Read 11 tweets

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