geoffrey modest medical blogs

  A new trial of remdesivir for treatment of patients with moderate Covid-19 pneumonia found a statistically significant difference in clinical status with the medication, though the difference was of uncertain clinical importance ( see  covid remdesivir review jama2020  in dropbox, or doi:10.1001/jama.2020.16349 )    Details: -- 580 for patients with confirmed SARS-CoV-2 infection by PCR and moderate Covid-19 pneumonia (pulmonary infiltrates and room air oxygen saturation >94%) were randomized to receive a 10-day course of remdesivir, a 5-day course of remdesivir, or standard care. Remdesivir was dosed at 200 mg on day one followed by 100 mg per day IV, in an open label trial in 105 hospitals in the US, Europe, and Asia between March 15 and April 18 -- median age 57, 39% women, 58% white/18% black/18% Asian/18% Hispanic, BMI 27, 84% were at clinical status 5 (see below) -- 56% had cardiovascular disease at baseline, 42% hypertension, 40% diabetes, and 1...

Finally, an actual large RCT on remdesivir in hospitalized Covid-19 patients, with preliminary results from the ACCT-1 study (Adaptive Covid-19 Treatment Trial): see  covid remdesivir RCT nejm2020  in dropbox, or DOI: 10.1056/NEJMoa2007764   Details: --1059    patients hospitalized with Covid-19 and evidence of lower respiratory tract involvement (radiologic chest infiltrates, room air oxygen sat <95%, mechanical ventilation/ECMO) were randomized to remdesivir vs placebo for up to 10 days       --they define the above as “severe disease”, but, as below, they did enroll some who were considered to have mild/moderate disease (oxygen sat >94%, resp rate <24 without supplemental oxygen) --60 trial sites globally, most in US (45 sites), followed by UK (5 sites), then Greece, Germany, Korea, Mexico, Spain, Japan, and Singapore --median age 59, 64% male, 53% white/21% black or African-American/13% Asian/23% Latinx, --median time from s...

A recent drug-company sponsored article just reviewed the data on compassionate use of remdesivir for COVID-19  infection, finding significant benefit ( see  c ovid remdesivir compassionate use NEJM2020  in dropbox, or DOI: 10.1056/NEJMoa2007016  ) Details: --61 patients received at least one dose of remdesivir, though 8 (of the 61 patients) did not have either post-treatment data or had a dosing error, so were not included. From 1/25/20 to 3/7/20 --median age 64, 75% men, 26% <50yo/40% 50-70/34% >70yo, --inclusion criteria included eGFR >30 and ALT and AST <5x upper limit of normal --median duration of symptoms prior to  remdesivir: 12 days --coexisting conditions: hypertension 25%, diabetes 17%, hyperlipidemia 11%, asthma 11% --30 patients (57%) were on mechanical ventilation; 4 (8%) ECMO --22 patients were from the US, 22 from Canada or Europe, 9 from Japan. --all patients had confirmed Covid-19 infections, oxygen saturat...