A thread on the recent #NEJM paper discussing compassionate-use of #remdesivir in #COVID19. No control group, no data on viral loads (for an antiviral drug), no measurements of efficacy other than clinical improvement based on oxygen requirements. (1/8)

At first glance, the improvement rate of 68% juxtaposed with 57% of patients on mechanical ventilation is impressive. However, randomized controlled data is necessary to validate that this is significantly different from standard of care. (2/8)

The bulk of the patient data is in Figure 2. Examining the patients on ECMO or mechanical ventilation (patients 1-34). Discharge rate of 23.5% and mean discharge time from the first dose of #remdesivir (not first day of hospitalization) ~23.6 days. (3/8)

With three weeks between discharge and first dose, the patients on EMCO/MV do not appear to benefit from #remdesivir, but from excellent ICU care. Without data on viral loads, temperature, lymphocyte counts, SpO2, creatine, CRP, etc. it is speculative anecdotal evidence. (4/8)

The majority of patients that were on ECMO/mechanical ventilation remain in the hospital. Thankfully, 18 of these patients showed improved oxygen requirements (8 of these were the discharged patients). Mean time to improvement after first dose of remdesivir is 9.6 days. (5/8)

#COVID19 patients on NIPPV, high/low-flow oxygen, or ambient air have a mean time to improvement of 6.8 days and discharge of 13.7 days from the first dose of remdesivir. (6/8)

Overall mortality of #remdesivir treated patients 13% compared with randomized trial from Wuhan where overall mortality rate was 22%. An overrun hospital in Wuhan is not comparable to a multi-center study with patients primarily in the United States, Japan, or Italy. (7/8)

Data from New York finds a mortality rate of 6.5% in hospitalized patients with comparable baseline O2 saturation. The mortality rate found with #remdesivir treated patients is within the range of standard of care for #COVID19 (8/8). https://www.medrxiv.org/content/10.1101/2020.04.08.20057794v1.full.pdf