Discover and read the best of Twitter Threads about #RECOVERYtrial
Most recents (22)
I'm sure well-intentioned @CamCavendish but this piece completely mashes up #datasharing for #DirectCare of a patient and data sharing for #ResearchAndPlanning, and other 'secondary uses'. These are VERY different in legal basis, IT systems, and privacy.
ft.com/content/dc01b3…
ft.com/content/dc01b3…
It's complex and it doesn't make for punchy articles, but it's very important that we are totally clear about the distinction between Direct Care and Planning/Research.
At present, data sharing for Direct Care STILL lags significantly behind data sharing for secondary uses
At present, data sharing for Direct Care STILL lags significantly behind data sharing for secondary uses
Because they are built on totally different technologies, progress towards Research and Planning uses of #GPData doesn't advance the cause for Direct Care one iota.
Which is why it's so important the distinction is made and understood. Conflating the issues is counterproductive.
Which is why it's so important the distinction is made and understood. Conflating the issues is counterproductive.
Our newest study of #emergingfungalinfections
Covid-assoc #aspergillosis reportedly occurs in <1/3 ICU patients, but dx is rarely biopsy confirmed
By reviewing autopsy studies, we found proven invasive mould infections occur in 2% of decedents w covid
sciencedirect.com/science/articl…
Covid-assoc #aspergillosis reportedly occurs in <1/3 ICU patients, but dx is rarely biopsy confirmed
By reviewing autopsy studies, we found proven invasive mould infections occur in 2% of decedents w covid
sciencedirect.com/science/articl…
Major caveat is that most autopsies included were from first wave, pre-#RECOVERYtrial and use of steroids and other immunomodulation likely increase risk of #CAPA.
NB to know your local epi, which may differ; for eg of centers reporting >>> rates, see link.springer.com/article/10.100… &👇
NB to know your local epi, which may differ; for eg of centers reporting >>> rates, see link.springer.com/article/10.100… &👇
Big congratulations to Dr Brittany Kula (@ScrofKula), ID fellow extraordinaire @UofA_ID and soon @UAlberta_ICU fellow, for doing a wonderful job leading this study. Brittany is pictured in the first tweet, and here is her cat Gladys
#DayOfReflection I treated hundreds of Covid patients in the last 12mo. I was the named consultant for 184 who died, equals to 16.2% of all Covid deaths in my Trust
I remember my colleagues from different specialties who volunteered to work with me on the pop-up EoL Covid ward, providing top class palliative care. At that time little was known about Covid, but it didn’t stop us from doing our best. That’s professionalism & bravery.
NEWS: #RECOVERYtrial demonstrates that tocilizumab reduces the risk of death in patients hospitalized with #COVID19
Read more ➡️ recoverytrial.net/news/tocilizum…
@NIHRresearch @The_MRC @OxfordMedSci
Read more ➡️ recoverytrial.net/news/tocilizum…
@NIHRresearch @The_MRC @OxfordMedSci
@NIHRresearch @The_MRC @OxfordMedSci A combination of dexamethasone plus tocilizumab reduces mortality by about one third for patients requiring simple oxygen and nearly one half for those requiring invasive mechanical ventilation
#RECOVERYtrial #COVID19
🌐 recoverytrial.net
#RECOVERYtrial #COVID19
🌐 recoverytrial.net
@NIHRresearch @The_MRC @OxfordMedSci The #RECOVERYtrial is a national effort with 177 recruiting sites and over 35,000 #NHS patients taking part
Thank you to everyone who has contributed to finding a second life-saving treatment for #COVID19
🌐 recoverytrial.net
Thank you to everyone who has contributed to finding a second life-saving treatment for #COVID19
🌐 recoverytrial.net
#Tweetorial
Llegó colección de lo #Mejor2020 en #PedsICU &
@Dr_Hari_Krishna 🇬🇧@MiguelrrMD 🇪🇸 @sgdambrauskas 🇺🇾
Pubmed: bit.ly/pedsicubestof2…
Versión infográfico español: bit.ly/bestof2020esp
Version inglés: bit.ly/bestof2020eng
#SoMe4MV #neuroPICU #delirium #PedsCICU
Llegó colección de lo #Mejor2020 en #PedsICU &
@Dr_Hari_Krishna 🇬🇧@MiguelrrMD 🇪🇸 @sgdambrauskas 🇺🇾
Pubmed: bit.ly/pedsicubestof2…
Versión infográfico español: bit.ly/bestof2020esp
Version inglés: bit.ly/bestof2020eng
#SoMe4MV #neuroPICU #delirium #PedsCICU
English #BestOf2020
The #Bestof2020 #PedsICU pubmed collection will also be available in the FREE #PICCHub app (sponsored by @PICSociety) as the latest monthly #PICUJournalwatch collection:
Download links: Android: play.google.com/store/apps/det…
iOS: apps.apple.com/gb/app/picchub…
The #Bestof2020 #PedsICU pubmed collection will also be available in the FREE #PICCHub app (sponsored by @PICSociety) as the latest monthly #PICUJournalwatch collection:
Download links: Android: play.google.com/store/apps/det…
iOS: apps.apple.com/gb/app/picchub…
3/ La FUNCIÓN como nuevo paradigma
@ericka_fink et al POST #PedsICU investigators & @PALISInet hicieron consenso Delphi
Qué es lo importante como resultados al alta #PedsICU?
En @CritCareMed lo que encontraron con precioso infogràfico
bit.ly/381cfq8
#PedsICU #PICSp
@ericka_fink et al POST #PedsICU investigators & @PALISInet hicieron consenso Delphi
Qué es lo importante como resultados al alta #PedsICU?
En @CritCareMed lo que encontraron con precioso infogràfico
bit.ly/381cfq8
#PedsICU #PICSp
It took a while to digest the details of over 600 pages, but here is my review and comparative analysis of the #ACTT2 trial that compared #baricitinib vs. #placebo among patients receiving #remdesivir for #COVID19!
Some very interesting insights, I think!
Sit briefly and enjoy!
Some very interesting insights, I think!
Sit briefly and enjoy!
Will be mainly comparing #ACTT2 to #ACTT1, but also will get some insights and questions that come up when comparing #ACTT2 to the #dexamethasone #RecoveryTrial
The idea of using #baricitinib (aka Bari) for #COVID19 is in this commentary in .@TheLancet from Feb. when Peter Richardson & Co working .@benevolent_ai .@ucl searched drugs and noted that #bari could block inflammation & viral endocytosis.
link: thelancet.com/journals/lance…
link: thelancet.com/journals/lance…
With the .@NIAIDNews #ACCT1 trial final report published on 05 Nov 2020 and the .@WHO's #SolidarityTrial Preliminary report published on 02 December 2020, thought it would be good to take another look at both trials and find ways forward for the patients we are dealing with today
Motivated by a patient I am dealing with who will survive very severe #COVID19 in the setting of transplant, but her father, who was hospitalized earlier than her with moderate COVID, was left to progress and died before her discharge, given #remdesivir only after going on #BiPAP
Here is the link to the prior analysis and I think the new publications give some interesting details which will follow
Time to share some thoughts and questions following the .@medrxivpreprint first release of results from the #SolidarityTrial that compared local standard care to #remdesivir, #HydroxyChloroquine #lopinavir_ritonavir and #interferon for treatment of patients with #COVID19
I have read the #solidarityTrial preprint: medrxiv.org/content/10.110…
Its supplementary material:medrxiv.org/content/10.110…
its posted protocol: who.int/publications/m…
The CRF: who.int/publications/i…
The final report from #ACTT1 for contrast: nejm.org/doi/full/10.10…
Its supplementary material:medrxiv.org/content/10.110…
its posted protocol: who.int/publications/m…
The CRF: who.int/publications/i…
The final report from #ACTT1 for contrast: nejm.org/doi/full/10.10…
Everyone has focused on the results, which is understandable, yet understanding the specifics in #SolidarityTrial design compared to the #ACTT1 design, may bring light into the differences reported between trials and may give a way to do better in #COVID19 #therapeutics
🛑The effect of corticosteroids on patients with Covid19: a SR /MA
➡️Corticost. could lead to ⬆️ mortality, LOS, rate of bacterial infection and hypokalemia. It should be used with caution in covid19; not recommended for patients with mild conditions
journalofinfection.com/article/S0163-…
➡️Corticost. could lead to ⬆️ mortality, LOS, rate of bacterial infection and hypokalemia. It should be used with caution in covid19; not recommended for patients with mild conditions
journalofinfection.com/article/S0163-…
🛑#SARS-CoV2 and immunosuppression: a double-edged sword
Otra de las grandes incógnitas es la evolución de los pts receptores de transplante ante la #Covid_19
▶️Resumen de evidencias (pocas), y manejo farmacoterapéutico
onlinelibrary.wiley.com/doi/epdf/10.11…
Otra de las grandes incógnitas es la evolución de los pts receptores de transplante ante la #Covid_19
▶️Resumen de evidencias (pocas), y manejo farmacoterapéutico
onlinelibrary.wiley.com/doi/epdf/10.11…
Añado al hilo, aporte de @fgilc y comentario de @Luis_Corral_Gud por ser de gran interés.
Interferón y desenlaces clínicos en #Covid_19
Interferón y desenlaces clínicos en #Covid_19
1/ A #MedTweetorial on #HowIReadThisPaper for #DISCOVERYtrial - dex edition on @medrxivpreprint. We’ll be exploring the pre-print, supplement, and trial document. Would love for feedback, thoughts, & comments!
Currently, what is your opinion on using dexamethasone?
Currently, what is your opinion on using dexamethasone?
2/ Trial info:
▶️RCT, open-label, adaptive
▶️6,425 pts enrolled
▶️Dex 6mg daily for 10d (PO or IV) v usual care (1:2 ratio, respectively)
▶️176 🏥in UK
▶️Prim Outcome: OS
🔑Intention-to-treat
🔑Pre-specified stats plan
🔑Not randomized by O2 status
▶️RCT, open-label, adaptive
▶️6,425 pts enrolled
▶️Dex 6mg daily for 10d (PO or IV) v usual care (1:2 ratio, respectively)
▶️176 🏥in UK
▶️Prim Outcome: OS
🔑Intention-to-treat
🔑Pre-specified stats plan
🔑Not randomized by O2 status
3/ Results - Table 1
✅Well-balanced between dex & usual care
▶️Younger, less-comorbid cohort on vent
▶️Days of illness ⬆️w/ ⬆️O2
Imbalances in O2/vent cohort raises ❓s
1️⃣How to account for O2 & vent?
2️⃣Can we adjust & trust result?
✅Well-balanced between dex & usual care
▶️Younger, less-comorbid cohort on vent
▶️Days of illness ⬆️w/ ⬆️O2
Imbalances in O2/vent cohort raises ❓s
1️⃣How to account for O2 & vent?
2️⃣Can we adjust & trust result?
My experience: #Covid_19 ICU rotation at #SGPGI #Lucknow
1. All patients were >35 years of age with majority being males
2. Apart from the usual comorbidities, central #obesity without over #diabetes or #hypertension also predisposed to #SARI
1. All patients were >35 years of age with majority being males
2. Apart from the usual comorbidities, central #obesity without over #diabetes or #hypertension also predisposed to #SARI
3. #Lymphopenia was a great marker of severity and a rising trend predicted clinical recovery
4. #recoverytrial further reiterated the use of steroids for patients with severe disease which many centers including ours was already practising
4. #recoverytrial further reiterated the use of steroids for patients with severe disease which many centers including ours was already practising
5. Although initially we had a guarded approach towards it, but #NIV with low pressures worked wonders avoiding intubation
6. Once intubated, outcomes aren’t great. Multiple reasons: severity of disease, nursing care and feeding becomes suboptimal, bradycardia associated with
6. Once intubated, outcomes aren’t great. Multiple reasons: severity of disease, nursing care and feeding becomes suboptimal, bradycardia associated with
So the #RECOVERYtrial RECOVERY dexamethasone study has been released as a preprint, although one should be careful of pre-prints, the team delivering this & the nature of the (non-commercial) study gives this strong preliminary validity. @PeterHorby medrxiv.org/content/10.110…
We’ve seen the headline result, dexamethasone reduces mortality in ventilated patients by 12% (relative risk reduction 30%) and 5% (relative risk reduction 20%) in patients needing oxygen.
A massive treatment effect, totally unbelievable? Whilst critical care is used to seeing relatively small treatment effects in-fact this is in keeping with the 15% ARR seen in heterogenous ARDS in Villar et al’s recent trial of steroids in ARDS pubmed.ncbi.nlm.nih.gov/32043986/
Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report | medRxiv #RECOVERYtrial
Congrats to @PeterHorby @MartinLandray & team on completing this impt trial. Thanks for making the preprint available so quickly. medrxiv.org/content/10.110…
Congrats to @PeterHorby @MartinLandray & team on completing this impt trial. Thanks for making the preprint available so quickly. medrxiv.org/content/10.110…
I suspect all major guidelines will soon recommend dexamethasone for #COVID19 patients receiving supplemental O2 or mechanical ventilation based on the #REVOVERYtrial
I’m not sure if it is knowable, but I’m interesting in how these results might be influenced by the relative strain on the NHS versus our experience in ANZ (where the mortality of mechanically ventilated patients is much lower even without dexamethasone).
Kudos to @MartinLandray and team, including all patients, practitioners, administrators, funders & researchers. Amazing study. This is the new standard about how to move quickly, thoughtfully and effectively in research. Now @medrxivpreprint. Pls comment. medrxiv.org/content/10.110…
@MartinLandray @medrxivpreprint This is a landmark event for #preprints. Major study opting to post @medrxivpreprint for comments so investigators & other interested parties around world can see the study and comment. Rapid communication. Complementary to peer-review publication. Thankyou #RECOVERYtrial team.
Also appreciation to all the journals that are now on board with #preprints. Almost all are supportive. We have come a long way… soon perhaps everyone will preprint at time of submission as they do in so many other fields. @jsross119 @cshperspectives @TheoBloom @JohnRInglis
Les cuento sobre la Dexametasona y los hallazgos del recovery trial de 🇬🇧
1. La dexametasona es un corticoide (anti inflamatorio esteroidal)
2. Este fármaco bloquea El Paso enzimatico para que los lípidos de las células (dañadas) se conviertan en ácido araquidonico (AA)
1. La dexametasona es un corticoide (anti inflamatorio esteroidal)
2. Este fármaco bloquea El Paso enzimatico para que los lípidos de las células (dañadas) se conviertan en ácido araquidonico (AA)
3. Este fármaco se aprobó por primera vez en 1961
4. Se lo usa generalmente para muchos procesos patológicos, entre ellos colitis, artritis, lupus, shock anafilactico y otras alergias etc
5. #covid19 genera un estado de respuesta inflamatoria aguda, por eso su uso
4. Se lo usa generalmente para muchos procesos patológicos, entre ellos colitis, artritis, lupus, shock anafilactico y otras alergias etc
5. #covid19 genera un estado de respuesta inflamatoria aguda, por eso su uso
Que encontró el #RECOVERYtrial
6mg/día de dexametasona x 10 dias
1. no mejora mortalidad en pacientes que no requerian oxígeno
2. Reduce de 25% a 20% la mortalidad en pctes con requerimiento de oxígeno
3. Reduce de 45% a 27% la mortalidad en pctes ventilados
6mg/día de dexametasona x 10 dias
1. no mejora mortalidad en pacientes que no requerian oxígeno
2. Reduce de 25% a 20% la mortalidad en pctes con requerimiento de oxígeno
3. Reduce de 45% a 27% la mortalidad en pctes ventilados
Updated the #RECOVERYtrial topline results summary table of the #dexamethasone arm compared to usual care for treatment of hospitalized patients with #COVID19.
Got additional information colleagues shared in Twitter.
Thread with some comparisons with #ACTT1
#IDtwitter 1/
Got additional information colleagues shared in Twitter.
Thread with some comparisons with #ACTT1
#IDtwitter 1/
the #ACTT1 authors have only reported (preliminary) Day 14 mortality, and the #RECOVERYtrial has only posted Day 28 mortality.
But these days the Supplementary Appendices in trial reports have additional relevant information:
nejm.org/doi/full/10.10…
#DontCoverDiscover
But these days the Supplementary Appendices in trial reports have additional relevant information:
nejm.org/doi/full/10.10…
#DontCoverDiscover
The #medtwitter in the US has exploded with cynical and sometimes downright malicious voices after the #RECOVERYtrial announcement. I agree (as does the Trial steering committee based on the press release!) that policy change and implementation should only come after publication.
There are very important data omitted from the press release&the scientific community has every right to demand to see those in a peer-reviewed publication, which will certainly be dissected word-by-word. As a researcher leading this and other RCTs in my Health Board I'm biased.
I haven't seen the data as I'm only a contributor. What I'd like to highlight is the potential differences between UK and US healthcare and ICU in particular, to help understanding the numbers in the study.
The drug #dexamethasone is a steroid. Now the word "steroid" evokes all manner of reactions, but in essence medics use "steroids" mainly in exchange for a specific subgroup of the huge class of hormones and their analogues, namely the #glucocorticoid group.
All steroid hormones are produced in the body from cholesterol (don't worry statin users, there's plenty for everyone). They are converted by enzymes in various organs to specific hormones that are released and controlled by all manner of systems. (O)estrogen, progesterone...
... testosterone, cortisol and aldosterone are the main members. Each of these has intracellular receptors in their target tissues. They are fat-soluble and most of them need a carrier protein in the bloodstream to actually circulate around the body (e.g. SHBG, sex hormone...
A nice opportunity for me to show the usefulness of this:
It may surprise folk to know that many modern-day medical interventions [including 'ahem' exercise) are far from miracles (see examples in pic). But NNT of 8 & 25 is right up there w the best.
/1
It may surprise folk to know that many modern-day medical interventions [including 'ahem' exercise) are far from miracles (see examples in pic). But NNT of 8 & 25 is right up there w the best.
/1
Borrowing* figures from:
(*herein lies one of the problems with press-released data raised by others:
)
We can use @d_spiegel tool to explore how we can communicate the #RECOVERYtrial findings
understandinguncertainty.org/node/233
/2
(*herein lies one of the problems with press-released data raised by others:
)
We can use @d_spiegel tool to explore how we can communicate the #RECOVERYtrial findings
understandinguncertainty.org/node/233
/2
Let's look at the group of patients who required 02 but not ventilation:
We first determine the proportion (risk) of people that died in the group NOT receiving dexamethasone (dexa) =
2750/550 = 0.20 (20%). Note that 80% of these people survived with no dexa anyway.
/3
We first determine the proportion (risk) of people that died in the group NOT receiving dexamethasone (dexa) =
2750/550 = 0.20 (20%). Note that 80% of these people survived with no dexa anyway.
/3
Those of us following #RECOVERYtrial know it’s one of the most important clinical trials for COVID-19, not just for its potential to identify new therapeutic options but also to temper the excitement over unproven therapies. 1/
My thoughts on the RECOVERY trial PRESS release on mortality benefit for COVID-19 with dexamethasone.
RECOVERY trial is a large randomized controlled trial with multiple arms. 11k+ patients and multiple treatments being evaluated. See image for therapeutics under evaluation. 2/
RECOVERY trial is a large randomized controlled trial with multiple arms. 11k+ patients and multiple treatments being evaluated. See image for therapeutics under evaluation. 2/
First, what is dexamethasone?
Dexamethasone is a corticosteroid, commonly called a steroid (not the anabolic kind). In addition to many other effects, it can reduce the inflammatory resonse caused by an out of control immune system. 3/
Dexamethasone is a corticosteroid, commonly called a steroid (not the anabolic kind). In addition to many other effects, it can reduce the inflammatory resonse caused by an out of control immune system. 3/
Tabulated the topline results released by the #recoverytrial team on #hydroxychloroquine & #dexamethasone, and went over their protocol (recoverytrial.net/results) to better digest them.
Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Important point from #RECOVERYTrial protocol
- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
So if a patient enrolled in #recoverytrial had a contraindication to #dexamethasone, that patient was not allowed to be randomized to that arm. So the results need to be interpreted in the context of no contraindication to steroids: already on steroids, #immunosuppression, etc.
I want to highlight the story of Hydroxychloroquine, as although the evidence is shifting against this drug being effective in COVID-19, it is a complete failure in the scientific method, and the way clinical research is allowed to function
Thread below 1/
Thread below 1/
As the seeds of a pandemic grew, invitro studies flourished. One such potent drug was chloroquine - which showed cytotoxic effects. Given this and hydroxychloroquine were oral, globally available, cheap, and had decades of safety, there was hope
nature.com/articles/s4142…
2/
nature.com/articles/s4142…
2/
What happened next was strange. Multiple people sent me "one pagers" on how to manage COVID from China, Italy, and the USA. CQ or HCQ was on all of these, often given with some sort of witchcraft concoction and indication. At the time there was no data supporting it's use. 3/
