Some thoughts about the recent publication of the DASH trial for posterity @MatthewPCheng @SamuelDM18 @AlexLawandi @GBL_Unit @McGill_DOM @IDIGHProgram

Article
https://doi.org/10.1093/cid/ciaa1000

With thanks to @ABsteward for letting us know it was published https://twitter.com/ABsteward/status/1283518603313188864?s=20

In 2016 @MatthewPCheng was a fellow here. I had transitioned from clinician-teacher to clinician-scientist and had become interested in trials. After he had visited Australia and met with the great team there, we had a dream to join the #CAMERA2 study https://jamanetwork.com/journals/jama/article-abstract/2760737

Unfortunately, that couldn't work out due to insurance reasons. But it got us thinking that we could stake out a space in the SA bacteremia trial world. We thought - what if we could reduce duration of bacteremia like people used to do with gentamicin, but without the AKI?

Settled on the idea of leveraging bactericidal activity of DAPTOMYCIN which, itself, could be used to treat MSSA bacteremia. Was a swing for the fences - this could either work or not. No one had published on it before. It was going to be a lot of work and we had skeleton budget

Necessity was mother of invention and concept of the "Fellows trial" was born. I had $40000CDN of remaining research funds from the @McGill_DOM.

With that, we would buy the daptomycin/pay research pharmacy. With trainees involved, was important to me this was industry-free.

With guidance, the fellows/residents would design and run this trial as part of a longitudinal education. Shortly thereafter @AlexLawandi and @GBL_Unit joined the team with @SamuelDM18 joining later on when he was accepted to our fellowship program.

These superstars did *everything*. Helped write the protocol, helped design the database, obtained ethics approval, figured out how to get notified by the lab of cases, did the academic detailing necessary to get buy in for the trial in our center --- and then......

Recruited each and every patient. They wore a pager and took turns on evenings and weekends. On their spare time. During Christmas break! The high recruitment rate and fact we got this done was all fruits of this labor

4 generations of trainees worked together! Incredible.

The choice to have a placebo control was so important. People in our institution became big believers that DAPTOMYCIN was working. Colleagues were certain that it worked. It became more challenging to get people into the RCT vs. open-label use. Fortunately, science prevailed

But the DAPTOMYCIN genie was out of the bottle. We have a fascinating follow-up paper we are seeking to get published which will be instructive in this regard. More on this when someone accepts it :)

When we recruited the last patient - team cleaned database, completed follow-ups, and together we performed the analysis and wrote the manuscript.

It's an understatement to say that when we saw it didn't work we were disheartened. But that's a valuable lesson on why we do RCTs

During the course of the trial two of our fellows graduated:

@MatthewPCheng went to Harvard for a research fellowship, and has now returned here as faculty.

@AlexLawandi went on to the NIH in a critical care/anti-microbial resistance fellowship

@SamuelDM18 is finishing his residency as a PGY6 in medical microbiology and @GBL_Unit has gone on to a post-graduate research fellowship in our clinician-investigator program @mcgillu

Very proud of all of them. We started this together and learned invaluable lessons.

And, at the end - Canada's largest SA bacteremia RCT ever. One of larger SA bacteremia RCTs performed (for such an important disease!).

It was conducted with $40000 supplemented by blood, sweat, and tears. Many lessons were learned. Careers transformed.

10/10 would do again

(and we will -- second ID fellows trial very much in the works -- ideally this time Quebec-wide)

/end