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Vincent Rajkumar Profile picture
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25 Mar, 4 tweets, 2 min read
Friends in India: Please get COVISHIELD or COVAXIN whichever is available to you. Whichever is offered to you. They are both excellent highly effective vaccines.

Ignore the recent drama over the Astra Zeneca press release. Much ado about nothing. @nramind
The initial press release said 79% overall efficacy, with 100% efficacy against hospitalizations and severe disease based on interim analysis.

The primary efficacy analysis shows 76% overall efficacy, with 100% efficacy against hospitalizations and severe disease. @GargiRawat ImageImage
COVAXIN has reported 81% overall efficacy. @BharatBiotech
There is unnecessary confusion and nitpicking when the message should be one of clarity:

These are amazingly effective vaccines that you should try and get as soon as you can.

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Vincent Rajkumar Profile picture
27 Mar
As Congress announces it will look into the price of insulin, here are slides from a talk I gave in 2018 on the problem. #Insulin4All @RepKatiePorter

Prepare to be shocked.
If you would rather read the paper. Here it is in @MayoProceedings published Jan 1, 2020. I've summarized the problem. mayoclinicproceedings.org/article/S0025-…
Or you can watch or listen to my lecture. Insulin an Beyond.
Read 5 tweets
Vincent Rajkumar Profile picture
27 Mar
Breaking News: lde-cel (Abecma; idecabtagene vicleucel), approved by FDA for multiple myeloma.

This is the first CAR-T therapy for myeloma. Many patients have been waiting for this good news. @agarwalonc @BMS_Myeloma_US @bluebirdbio news.bms.com/news/corporate…
Here is the data that led to the FDA approval published in @NEJM

73% response rate; 33% CR rate; 26% MRD-
Median PFS 9 months

Congrats everyone. Nikhil Munshi, @ldandersonjr @ninashah33 @DMadduri @BerdejaJesus @SagarLonialMD @NoopurRajeMD @YiLinMDPhD nejm.org/doi/full/10.10…
Side effects: Milder in my experience than approved lymphoma CAR-Ts. Grade 3 or higher cytokine release syndrome (CRS) in 5% of patients. Grade 3 neurotoxic effects in 3%.

Overall well tolerated.
Read 5 tweets
Vincent Rajkumar Profile picture
26 Mar
You must concede this is pretty amazing. Epidemiological principles work, even if the pandemic starts in your own backyard with 70,000 cases. ImageImage
In response to China is not a democracy and so it works argument: No it can be done in a democracy too. S. Korea did it despite starting with 10,000 cases by April 1. ImageImage
There were countries like Australia and N. Zealand that did it by preventing COVID entry (border control)

But countries like China and S. Korea did the amazing job of containing a highly transmissible respiratory pandemic that already infected thousands within their borders.
Read 4 tweets
Vincent Rajkumar Profile picture
25 Mar
For the public to know about Data Safety Monitoring Boards (DSMBs).

Ive been on DSMBs for trials led by colleagues. Those colleagues have been on DSMBs for trials led by me. People in DSMBs don't necessarily have some special superior skills to the study team. And vice versa.
DSMBs in randomized trials get to see data ahead of the study team investigators and decide if any safety concerns and to decide when to stop the trial/release results either because the endpoint was met or there was futility or a safety issue.
The DSMB is independent of the study team and does what is in the best interest of the trial participants and the public.

Their advantage comes from access to data early and without the bias that a study team may have.
Read 5 tweets
Vincent Rajkumar Profile picture
25 Mar
Updated progress towards herd immunity in USA:
~30 million have had COVID
~85 million have received at least 1 dose of vaccine
(~70 million are children)

~100 million to go to get 80% of eligible population immune —an overestimate coz it excludes people who had undiagnosed COVID
I'm excluding people who have had COVID by seroprevalence because 1) it's hard to get a good idea of the % for the whole country; 2) the immunity from mild COVID may not be as robust; 3) Im excluding children so it compensates on the other end; 4) meant to be worst case scenario
At the rate we are vaccinating we are within 1-2 months of where we need to be. Which is good news.

I've said for months that we are closer to herd immunity than we think we are. Because of other factors. But that was a soft call. This time with vaccines I'm more confident.
Read 5 tweets
Vincent Rajkumar Profile picture
25 Mar
All this quarrel was over whether Astra Zeneca vaccine is 79% effective or 76% effective.

Pundits/Experts: Don't let irritation with how the company managed the trial supersede the fact that this is a great vaccine that saves lives.

Don't become a reason for vaccine hesitancy
Your wanting to sounding wise may lead to more vaccine hesitancy.

Be clear on how unbelievably good the vaccine is. That's the truth. Analyze the data & present the efficacy and safety results.

Hold your thoughts on how the company could have better publicized the results.
There is just too much bashing of a vaccine over process and details and too much missing the big picture.

There is no evidence that the integrity of the randomization was compromised. The vaccine works. Really well.
Read 6 tweets

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