Thread by @meganranney, Many of us are about the news that remdesivir may not, actually, [...]

Megan Ranney MD MPH 🗽

meganranney

Many of us are

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤷🏽‍♀️" title="Achselzuckende Frau (mittlerer Hautton)" aria-label="Emoji: Achselzuckende Frau (mittlerer Hautton)">about the news that remdesivir may not, actually, change mortality for #COVID19.

Why?

https://www.nytimes.com/2020/10/15/health/coronavirus-remdesivir-who.html">https://www.nytimes.com/2020/10/1... @KatherineJWu @ginakolata

Remdesivir Fails to Prevent Covid-19 Deaths in Huge Trial

Critics said the study, sponsored by the W.H.O., was too poorly conducted to be definitive.

https://www.nytimes.com/2020/10/15/health/coronavirus-remdesivir-who.html

First: a prior series of articles about remdesivir in @NEJM - including one from 10/8 - suggest at best, minimal effects of this drug. It may decrease time to recovery... but also, may not. No effect on mortality.

So this result is not surprising. https://www.nejm.org/doi/full/10.1056/NEJMoa2007764">https://www.nejm.org/doi/full/...

Remdesivir for the Treatment of Covid-19 — Final Report | NEJM

Original Article from The New England Journal of Medicine — Remdesivir for the Treatment of Covid-19 — Final Report

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

Second: the new preprint SOLIDARITY study was HUGE, but also included a number of other treatments, and a wide heterogeneity of healthcare systems & standards.

So despite its great statistical power, it has limitations, which stop us from "throwing the baby out."

Third: Like the NEJM studies, this study gave remdesivir to the sickest patients.

Some suspect that it may be more effective in LESS sick patients - those who have not yet experienced the immunologic over-reaction that causes the worst symptoms of #COVID19.

..... At the end of the day, to many of us, this feels similar to oseltamavir (aka Tamiflu), which may/may not actually help in severe flu, but which we give anyhow, because we have no good alternatives https://www.center4research.org/tamiflu-not-tamiflu/">https://www.center4research.org/tamiflu-n...

To Tamiflu or Not to Tamiflu? | National Center for Health Research

The flu is hitting hard friends and family may be sick already. Here is the information you need to know about current treatment options for the flu.

https://www.center4research.org/tamiflu-not-tamiflu/

We worry that this is a medication in search of a use.... and that we are all so desperate for a treatment, that we& #39;ll take the smallest signals of efficacy and run with it.

/ fin

@jeremyfaust @celinegounder @tmprowell

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