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Vincent Rajkumar Profile picture
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18 Jun, 5 tweets, 2 min read
A U turn in the UK due to the delta COVID variant. #GetVaccinated
For those reminding me that we should worry about deaths not cases: I said the same. Then the delta variant & India crisis happened. I still think the vaccines we have will do the job. But we need to improve vaccination rates coz 44% of population fully vaccinated is not enough.
If you are fully vaccinated, you are protected. Tell your friends to get vaccinated if they haven't already.

If you are eligible and have not been vaccinated, get vaccinated. Don't take chances with this one. Not worth it.
For a great analysis that balances the protective effect of vaccines we are seeing with the very real increase in hospitalizations although lower in rate see below.
More here on why states with low vaccination rates should take notice. bloomberg.com/news/articles/…

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Vincent Rajkumar Profile picture
16 Jun
The RECOVERY trial for COVID is the trial that keeps giving. Has already identified 3 life-saving treatments. Found 6 treatments to be not useful.

Publicly funded. Clinically relevant

Why are we not able to do such trials in the US?

1) Poor funding for RCTs
2) Too many cooks
The RECOVERY trial in reality is multiple randomized trials in one. Each trial will cost an order of magnitude more to run in the US. We simply do not have the public funding to support RCTs. Which is a tragedy given how much we spend, and how much we can gain.
@NIH @NIHDirector
I have led several RCTs. Some through NIH. Some through Pharma.

The NIH trials were like pulling teeth. The Pharma trials were far easier to pull off. So besides lack of funding we also have a process problem for publicly funded trials. See below.
Read 4 tweets
Vincent Rajkumar Profile picture
14 Jun
Requesting FDA & CDC to provide guidance on these 2 questions that many concerned citizens are asking

1. Should patients on chemotherapy/immunosuppression get neutralizing antibodies checked, and if negative get a booster?

2. Should people who got single dose J&J get a booster?
We have data that neutralizing antibody levels are predictive of protection.
We also have data that one dose of vaccine is only 33% effective against symptomatic COVID cause by delta variant (AZ or Pfizer). Versus 51% against alpha.

2 doses Pfizer 88% against delta versus 93% against alpha.

2 doses AZ 60% (delta) vs 66% (alpha)
medrxiv.org/content/10.110…
Read 5 tweets
Vincent Rajkumar Profile picture
12 Jun
For those of you interested in multiple myeloma, here is a brief state of the science for treatment.

1/ For newly diagnosed patients, triplets, VRd or DRd, are the standard of care. Current RCTs are examining if we can improve outcome using quadruplets. Eg. PERSEUS trial.
2/ In newly diagnosed myeloma, another question given the cost & potential toxicity of quadruplets is to start with a triplet, and based on MRD status identify patients who need 4 drugs versus this who do equally well with 3 drugs. Eg: EQUATE trial. @myelomaMD @mtmdphd @eaonc
3/ Auto stem cell transplant is still standard of care for eligible patients. Current data indicate overall survival is similar whether the transplant is done early or delayed. But for many reasons we prefer early transplant for most patients.
Read 7 tweets
Vincent Rajkumar Profile picture
11 Jun
The delta variant is the triple threat I have talked about. I am not saying this lightly. I take no pleasure in alarming people. It's just the facts after 2 months of being closely involved with the India COVID crisis. This is not last years COVID. Get vaccinated.
The message is not alarm. The message is that there is an easy solution that works. #GetVaccinated
More here from @EricTopol
Read 5 tweets
Vincent Rajkumar Profile picture
10 Jun
When the FDA approves a drug, it is not only approving the drug. Its actions provide prolonged monopoly protection to a drug in a country where the seller can set whatever price they want, the buyer cannot negotiate price, and competitors will face more severe barriers to entry
If like other Western countries we had a 2-step process for prescription drugs: regulatory approval followed by value based pricing determination, I would have less problem with an FDA that is more lenient.
If like other countries barriers to market entry to competition are not so hard, then I would have less problem with an FDA that is more lenient.
Read 5 tweets
Vincent Rajkumar Profile picture
9 Jun
Vaccine hesitancy in alive and well in the US. And it is going to cost lives. The level of vaccination we have in the US is simply not sufficient against the delta variant.

Friends: tell unvaccinated friends to get vaccinated.

Leaders: lead. Talk to your constituents. Beg them
30 million people who got one dose of vaccine need second dose. One dose is not enough.

Another 60-100 million people need to be fully vaccinated.

Get vaccinated even if you had COVID before.

Im trying not to be alarmist even though I'm extremely worried.
The delta variant is a triple threat. It is here.

1) More transmissible: In India, If often if one family member had it, everyone got it.

2) Vaccine evasive: In UK study a single dose of Pfizer or AZ had only 33% protection against symptomatic COVID.

3) Likely more virulent
Read 8 tweets

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