Thread by @DrMattMcCarthy

Speaking to students at @wakeforestmed today about the best ways to communicate the avalanche of new #COVID19 information to patients. The challenge: Enthusiasm for a new drug may be inversely related to the quality of data supporting its use. 1/

The two most controversial drugs at the moment are ivermectin and tocilizumab. Over the past few months, some doctors have been prescribing ivermectin (an anti-parasitic) to newly-diagnosed #COVID19 patients. The change in practice may be due to two things:

1) There aren’t many treatment options for non-hospitalized #COVID19 patients and 2) Ivermectin has been shown to inhibit the replication of #coronavirus in a lab. It may also work as an anti-inflammatory.

Two problems: 1) Very high doses of ivermectin doses may be required to achieve the desired effect (up to 100-fold higher than those approved for use in humans) and 2) The ivermectin data we have from human trials is modest at best.

The ivermectin story is incomplete. Trial data is limited by small sample size and inconsistent dosing, patient outcomes, and study populations. The trials may sway some physicians, but not most. It's important to have a coherent message for patients.
covid19treatmentguidelines.nih.gov/statement-on-i…

Tocilizumab is a different challenge: We have better data but the results conflict. There may be a narrow window to use this anti-inflammatory drug—perhaps for patients nearing the ICU—but we haven’t firmly defined that yet. Experts continue to disagree. 
covid19treatmentguidelines.nih.gov/statement-on-t…

Explaining these nuances to patients is something I wrestle with every day, and it's only getting more complex. I’ll also join fellow physician-authors to discuss the thing that occupies most of my free time: medical writing.