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Phil Yin Profile picture
Phil Yin
@YinPD
Bugs, drugs and hugs: infectious disease (MD/PhD, NIAID Infectious Dz), drug development (15 years), healthspan (the future: lifestyle med). Thoughts r my own.
Apr 21, 2020 • 7 tweets • 2 min read
1/7 THREAD: This is valuable framework to relate experimental COVID therapeutic interventions and stage of disease. Some interventions work better "early" when disease is less severe, and some more useful in "late" disease is more severe 2/7 For "supportive" therapy and "Immunomodulators" makes sense to use late/severe disease. However, there is role for immunomodulators earlier, to PREVENT risk of immunologic mediated events (ie ARDS, cytokine storm) for those at risk. It depends on the MoA.
Apr 18, 2020 • 13 tweets • 3 min read
THREAD 1/X The value of any drug is based on its benefit/risk. The benefit of #hydroxychloroquine for COVID19 is unknown, but HCQ risks should be quantifiable, given its long history of use for rheumatologic disease and malaria. 2/13 The most serious of these risk of HCQ/CQ is cardiotoxicity. Although rare, given the serious and potentially fatal outcomes this adverse outcome weighs most heavily for prescribers intent on using these drugs for COVID19
Mar 30, 2020 • 11 tweets • 3 min read
THREAD (30Mar2020 BREAKING): 1/X Newly publicized study by Chen evaluating #hydroxychloroquine (HCQ, N=31, 200 mg bid) vs control (N= 31) for 5 days in MILD #covid19 patients, showing improved clinical outcomes and chest CT favoring HCQ.
medrxiv.org/content/10.110… 2/X. Key endpoints were pre-defined time to clinical recovery (TTCR) which included cough and temperature. An evaluation of CT scan was done, although unclear if readers were blinded or not. Importantly viral load was NOT measured (or not reported) unfortunately.
Mar 29, 2020 • 16 tweets • 5 min read
THREAD (1/X) It's interesting that favipiravir (Avigan), is getting relatively little press in U.S. and western countries compared to #hydroxychloroquine (HQ). #COVID19 pilot data at least as promising as any currently available HQ data presented thus far. 3/X Currently data supporting FPV (oral) comes from a Chinese open label pilot study.
It was NOT randomized, but patients were consecutively screened, which means they weren't cherry picked. Lopinavir/ritonavir (LPVr) was used as an active control
sciencedirect.com/science/articl…
Mar 25, 2020 • 13 tweets • 6 min read
THREAD 1/X Data available from NEW Chinese #Hydroxychloroquine #SARSCoV2 study conflicts with recent French #Hydroxychloroquine (and #Azithromycin) study touted by US politician. zjujournals.com/med/article/20… and mediterranee-infection.com/wp-content/upl… My thoughts: 2/X Both are small pilot studies and REQUIRE FURTHER VALIDATION. Viral load is the endpoint (not clinical outcome). This is important regardless because decrease shedding duration may have important #publichealth implications, and viral burden could impact cytokine storm risk