1/ BREAKING NEWS... #POTUS has #COVID19 so it seems like a good time to review the therapies with established efficacy in RCTs and when they should be used.

P.S. #Hydroxychloroquine is NOT effective and may cause harm #mythbusting #GoScience @CaulfieldTim

2/ Here is a great resource https://www.ashp.org/COVID-19  which updates the latest evidence on emerging therapies

3/ It is important to recognize the clinical stages of #COVID19 from Stage 1 (at home), Stage 2a (hospitalized but not requiring oxygen), Stage 2b (hospitalized requiring oxygen) and stage 3 (requiring ICU and mechanical ventilation)

Image Source: https://www.nature.com/articles/s42255-020-0237-2

4/ For Stage 2a patients (in hospital NOT requiring O2)

5 days (but not 10 days) of #remdesivir was found to statistically improve clinical status on Day 11 vs standard of care (70% vs 60% discharge)

Note: 200mg IV day 1 and 100mg IV day 2-5

https://jamanetwork.com/journals/jama/fullarticle/2769871

5/ For Stage 2b patients (in hospital requiring O2)

#remdesivir significantly improved time to recovery (11 d vs 15 d) although 14d mortality (7.1% vs 11.9%) not statistically significance. The largest benefit in those on O2 (no clear benefit in ICU)

https://www.nejm.org/doi/full/10.1056/NEJMoa2007764

6/ For Stage 3 patients (in ICU)

RECOVERY Trial showed benefit of #dexamethasone in patients on supplemental O2 (largest benefit seen in those on a ventilator).

NOTE: There was harm if dexamethasone is given to those not requiring O2 (stage 2a)

https://www.nejm.org/doi/full/10.1056/NEJMoa2021436

7/ WARNING: COVID drugs can cause drug induced liver injury:

#DILI difficult to diagnose as abN #liver tests common in COVID19 (esp. in ICU)

WHO Vigibase analysis suggests #DILI with remdesivir

Be aware of interactions = remdesivir + p-glycoprotein inhibitors

#livertwitter

8/ SUMMARY

Based on the results of randomized clinical trials there is evidence to support the use of:

Remdesivir in hospitalized patients (Stage 2)

and

Dexamethasone in patients requiring O2 (Stage 2b), but most benefit was seen in patients on a ventilator (Stage 3)

9/ ACKNOWLEDGEMENT

Special thanks to @AntibioticDoc for highlighting these studies and resources during our @CME_UofC #COVIDCorner

More information can be found at https://cumming.ucalgary.ca/cme/COVID-19-Resources/COVID-Corner