Discover and read the best of Twitter Threads about #Toci
Most recents (2)
Updated WHO severe COVID treatment guidelines bit.ly/3rhGgKW
Recommended
🟢Steroid (#Dexamethasone)
🟢IL6 blocker (#Toci) or 🟢JAKi (#Baricitinib)
🟠±mAb in seronegative people
NOT recommended
🔴#Hydroxychloroquine
🔴#ivermectin
🔴#remdesivir
Lots to discuss, a🧵
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Recommended
🟢Steroid (#Dexamethasone)
🟢IL6 blocker (#Toci) or 🟢JAKi (#Baricitinib)
🟠±mAb in seronegative people
NOT recommended
🔴#Hydroxychloroquine
🔴#ivermectin
🔴#remdesivir
Lots to discuss, a🧵
1/
Remdesivir (RDV) is in the “We suggest no remdesivir” category.
At some level, this isn’t too surprising & is old news.
Despite initial hype, RDV never moved the needle much on patient centered outcomes (risk of mortality or requiring IMV) & many of us had stopped using it.
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At some level, this isn’t too surprising & is old news.
Despite initial hype, RDV never moved the needle much on patient centered outcomes (risk of mortality or requiring IMV) & many of us had stopped using it.
2/
In #ACTT1 RDV did improve outcomes on an ordinal scale, but the effect was modest. It shortened time to clinical improvement but not hospital LOS (patients stayed in the hospital longer to receive it).
RDV did NOT improve mortality or risk of IMV.
ncbi.nlm.nih.gov/pubmed/32445440
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RDV did NOT improve mortality or risk of IMV.
ncbi.nlm.nih.gov/pubmed/32445440
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Following @remap_cap & #RECOVERY #Tocilizumab results, @NIHCOVIDTxGuide has updated guidelines:
-#Toci + #Dexamethasone now recommended for all ICU pts on IMV, NIPPV, or HFNC
-Toci + Dex recommended for non-ICU pts w/ rapidly increasing O2 needs & elevated inflammatory markers
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-#Toci + #Dexamethasone now recommended for all ICU pts on IMV, NIPPV, or HFNC
-Toci + Dex recommended for non-ICU pts w/ rapidly increasing O2 needs & elevated inflammatory markers
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You can read the updated NIH COVID19 treatment guidelines here: covid19treatmentguidelines.nih.gov/statement-on-t…
IMO, this change makes sense based on the published & pre-published data, which I discussed last month:
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IMO, this change makes sense based on the published & pre-published data, which I discussed last month:
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There are some caveats:
-Toci must be combined with dexamethasone (not given alone; ? harm signal)
-It should be given early (w/i 3 days)
-Toci should NOT be given to people who are already immunosuppressed or who have “an uncontrolled” infxn (e.g. getting worse despite Abx)
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-Toci must be combined with dexamethasone (not given alone; ? harm signal)
-It should be given early (w/i 3 days)
-Toci should NOT be given to people who are already immunosuppressed or who have “an uncontrolled” infxn (e.g. getting worse despite Abx)
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