Thread by @WesElyMD

1/ Imatinib for #COVID19: @TheLancet

This study of N=385 ICU pts tested a Tyrosine-Kinase Inhibitor vs. Plac for 9 days. It’s important because it did NOT decrease ventilator or oxygen needs BUT reduced death at 28 days. What does this mean?

bit.ly/3gFJELG

#MedTwitter

2/ This study is technically “negative” because it didn’t hit the primary endpoint scientists “guessed” ahead of time as best choice to see if the drug works in #COVID: time to stopping ventilation & O2. Importantly, we sometimes GUESS WRONG! Next let’s look at other endpoints!

3/ This drug stops lung & blood vessel membranes from going haywire. It did not have safety problems & decreased DEATHS by ~50%, TIME on VENT by 5 days, length of ICU stay a WEEK, #delirium by 5%. These are huge improvements that I would want if I had #COVID. ( Fig 2, Tab 2/3)

4/ Look at Fig 3 bar-chart of patients’ overall clinical status at end of treatment & day 28. You see way less pink (death), more purple (discharge to home but on O2) & more yellow (full recovery). Good right? This is not the appearance of a negative study! It’s very positive.

5/ CAVEATS: it took nine months to enroll these pts, so there was a mix of no steroids (March to July) & steroids (July to Jan). Imatinib is metabolized by our CYP3A4 enzyme, so antibiotics & other drugs can affect Imatinib levels in the individual person.

6/fin - We are learning!
1. A “negative” study due to an incorrectly guessed primary outcome might still offer LOTS of benefit to patients.
2. Drugs like Imatinib👇that reduce #COVID’s harm on lung membranes & blood vessels may offer striking help to patients.