F. Perry Wilson, MD MSCE Profile picture
Jun 30, 2021 11 tweets 10 min read Read on X
JUST OUT in @NEJM: Safety / Efficacy data for @novavax COVID-19 vaccine.
-89.7% efficacy against symptomatic COVID-19
-86.3% against alpha variant (B.1.1.7)
-96.4% against other variants
-NO hospitalizations, NO deaths in vaccine arm
DOI: 10.1056/NEJMoa2107659

Brief thread:
@NEJM @Novavax The @novavax vaccine is a (spike) protein-based vaccine, with an adjuvant that psychs up the immune system. This is older tech, like pertussis / Hep B vaccines - and may (?!) be more acceptable to those who are a bit nervous about mRNA vaccines.
@NEJM @Novavax This report is on the UK trial - 15,000 participants. Half got placebo, half the vaccine (which is 2 doses, 21 days apart).
UK means this is mostly white people, though US data seems similar.
@NEJM @Novavax Efficacy 7 days after dose two is solid at near 90%. Starting the clock after dose 1 is, as expected, not as good - 70% or so. We'll need both doses I think.
@NEJM @Novavax Trial was conducted at B.1.17 (Alpha) variant was kicking off in the UK. Efficacy very good here as well. Great news.

Don't get too excited about the high efficacy against "other variants" though - no Delta in the population at the time this trial was going.
@NEJM @Novavax On to safety...
Systemic adverse events worse in vaccine group, particularly after dose 2 which we've come to expect. Most not severe.
@NEJM @Novavax A bit of a different side-effect profile than the @pfizer and @moderna shots. Less fever here. But headache, fatigue, muscle pain pretty common. Feels like some folks might need to take a day off of work after this.
@NEJM @Novavax @pfizer @Moderna Digging into the supplement for details on the serious events. 44 in vax group, 44 in placebo group. Nothing standing out as a "signal" on my first pass. Here's the cardiac data for those worried about this:
@NEJM @Novavax @pfizer @Moderna People always ask about pregnancy. Pregnant women excluded (as ever) from this trial. Some women became pregnant, but I can't find a hard count. One miscarriage reported in the vax group.
@NEJM @Novavax @pfizer @Moderna Take home?
-Solid SOLID efficacy for this protein-based vaccine.
-No data on efficacy against delta though
-Side effect profile seems on par with mRNA vaccines
-No major safety signals.
@NEJM @Novavax @pfizer @Moderna I assume this will get an EUA. The big question is whether this more familiar vaccine tech will move the needle and get some folks into the vaccinated camp. I hope so.

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More from @fperrywilson

Feb 21
I've definitely noticed this phenomenon in American diet culture of late.
But high-protein diets may not be all they are cracked up to be. Why? A new study in Nature Metabolism puts the blame squarely on a single amino acid: leucine.
🧵 Image
OK there are three macronutrients. Your caloric intake will be comprised of some combination thereof, and basically all of the diet wars of the last 40 years can be cast in terms of macro content. Image
When I was growing up (it was a time called the 80s. Thing were... interesting) low-fat was the crazy. Remember "fat makes you fat"?
Read 20 tweets
Jan 9
Does it seem like your hospital patients are getting more... complicated? They are!
🧵 Image
Just went through this paper from @JAMAInternalMed which, like all good papers, comports with my prior beliefs ;-). No but seriously, I definitely feel like hospital complexity is rising. Image
Data comes from British Columbia - good for 2 reasons.
1) Universal EHR so you capture all hospital admissions
2) Universal healthcare - so you don't need to worry as much about access issues, etc.
Read 10 tweets
Nov 14, 2023
I believe that RNA therapeutics will completely transform medicine. Imagine a future where, instead of taking medications daily, you take a shot maybe once a year. That future is, basically, here.
🧵
Currently, this is more or less how our drugs work. They do something to a protein. Inhibit it, cleave it, block its binding to some receptor, speed its degradation, etc. Image
And, if you really think about it, disease is mediated by proteins. High cholesterol? Protein problem. Sepsis? Proteins. Viral infection? Viruses hijack our cells to make their... proteins.
Read 22 tweets
Oct 18, 2023
AI in Medicine is suffering from what I would like to call "The Cassandra Problem"
🧵(1/17)
I am thinking about this issues this week thanks to this study, appearing in @JAMANetworkOpen, which examines the utility of a model that predicts blood clots in hospitalized kids. (2/17) Image
The model takes in a bunch of data from the electronic health record, and makes what turns out to be a pretty accurate prediction about the risk of blood clot (AUC~0.90). (3/17)
Read 17 tweets
Sep 12, 2023
Absolutely fascinating @JAMA_current paper this week suggesting that Cerebral Amyloid Angiopathy may actually be infectious. (Thread) Image
The background here is that CAA is the second most common cause of intracerebral hemorrhage (brain bleed) after hypertension. There are some genetic causes, but most are thought to be idiopathic. Just amyloid getting deposited for no clear reason. Image
But there have been some clues that there might be a transmissible agent involved. This @Nature paper describes cases attributed to contaminated cadaveric pituitary hormone.
nature.com/articles/natur…
Read 14 tweets
Sep 6, 2023
37 degrees Celsius, 98.6 Fahrenheit. That's normal body temperature, right?
Wrong.
New data suggests true "normal" is 98.0 degrees. (thread)
We get 98.6 degrees from this guy Karl Wunderlich, who measured 1,000,000 temperatures from 25,000 Germans in the mid 1800s. He was really the first to realize that "fever" was not itself a disease, but a symptom of a disease. Image
He took the average, got 98.6, and that was that. UNTIL NOW.
(Ok honestly, people have known this was wrong for a while, but the new data is cool).
From @JAMAInternalMed: Image
Read 12 tweets

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