#Remdesivir new trial just published

Here are the clinical implications:
Canadian trial (CATCO) in hospitalized patients with #COVID19 bit.ly/33uktIf
Compared to ACTT-1 trial bit.ly/3msi1In in patients on supplemental O2 as recommended by guidelines
🧵1/
ACTT-1 Highly Significant Mortality Reduction in Patients on Supplemental Oxygen:
bit.ly/3msi1In
2/
Both CATCO and ACTT-1 trials showed
-No liver or renal toxicity with remdesivir, and
-No safety differences between remdesivir and controls in over 2300 patients

Thus, both trials show that remdesivir is safe, prevents intubation, and reduces mortality
3/
These results strongly support current guidelines recommendations to treat #COVID19 hospitalized patients on O2 with remdesivir:
@IDSA
@NIHCOVIDTxGuide
@ACPinternists
@SCCM
@ESCMID
Canadian Guideline
Australian Guideline
NICE-UK
Also many regulatory-eg FDA, EMA, Health Canada
4/
PINETREE bit.ly/32wh36D→remdesivir⬇️hospitalization/death (EARLY Tx)
ACTT1/CATCO→remdesivir⬇️intubation/death in hospitalized w/ O2 (LATE Tx)
Thus, is it ethical to not recommend it to hospitalized w/o O2 (MIDDLE Tx)-wait for worsening?
Time for guidelines’ update
5/
Both trials were not powered for subgroups-but most estimates favored remdesivir, and all 95%CIs overlapped➡️benefits cannot be distinguished by ordinal scores
Remdesivir benefits were independent of symptoms duration in both trials➡️indicates prolonged lung viral replication
6/
Length of lung viral replication varies individually

Viral load exposure, variant virulence, vaccine status, age, comorbidities, immunocompromise, clinical picture, and lung viral load are all relevant to maximize remdesivir treatment
7/
That is why the most optimal length of remdesivir therapy should be based on patient’s risks for prolonged viral replication/disease progression, and individual clinical recovery-not on a “fixed” duration

As we treat all our patients hospitalized with other severe infections
8/

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More from @DrAndreKalil

Jan 4
Should CDC recommend #COVID19 rapid antigen test for asymptomatic isolation exit?
R antigen test:
Picks up 2/100 who are contagious
Allows 3/100 to exit isolation still contagious
No help in 95/100
⬇️
Antigen test has no utility to exit asymptomatic isolation and may harm
⬇️
🧵1
FDA: Antigen test has a 60% false-negative rate in asymptomatic ppl at the infection start (screening)

Likely >60% at the infection end (isolation exit) → due to lower expected viral replication

But let’s use 60% assuming test will not lose performance at isolation exit
🧵2
CDC: 90-95% will not have any more replicable (no transmission) #Omicron at day 5

Asymptomatic at the infection end is even less contagious and

Vaccinated ppl are less likely to transmit

Thus the actual no transmission rate is >95%, but let’s use 95%
🧵3
Read 9 tweets

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