geoffrey modest medical blogs

A substudy of the ISCHEMIA trial assessed patients with stable coronary disease but advanced kidney disease, also finding no benefit from an invasive strategy over medical management    (see  cad stable CKD med management ISCHEMIA nejm2020  in dropbox or DOI: 10.1056/NEJMoa1915925 ). See  http://gmodestmedblogs.blogspot.com/2020/05/ischemia-trial-stable-angina-conserv.html  for details/critique of the larger  ISCHEMIA trial)   Details: -- the ISCHEMIA-CKD study began enrollment 2 years after the ISCHEMIA trial, though the two ran in parallel and were conducted at most of the same sites -- 777 patients with advanced kidney disease had moderate or severe ischemia on stress testing -- all patients had an eGFR <30 (47%) or were on dialysis (53%)      --  not on dialysis: median eGFR 23;  dialysis: median duration 2 years/84% hemodialysis, 15% peritoneal -- median age 63, 69% male, 64% white/8% Blacks/26% Asian, 61...

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...