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