Ok, so, what did the authors actually do? Well, they took a bunch of people who were given remdesivir while very sick with COVID-19 and followed them up for at least 1 day afterpic.twitter.com/cwiIdFKAOd
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On to the patient demographics It's a relatively young, although fairly unhealthy population About what you'd expect given the inclusion criteria (although a bit younger perhaps)pic.twitter.com/TKCQ04GwFC
And here we get to the main results Of the patients (53) treated with remsevidir, most improved! The death rate also appears to have been pretty low at only 13% (7/53)pic.twitter.com/8VogvKfDxU
Remember, these were VERY sick people. In groups admitted to an ICU for #COVID19, the median death rate is usually around 30%
The authors have constructed an arbitrary ordinal scale here from 1-6, where 6 is the worst (death) and 1 is the best (discharged) Based on this scale, most patients improved on remdesivirpic.twitter.com/UtcUDlTvzX
HOWEVER, there was a huge issue here Most patients didn't have the follow-up required to perform this calculation. In fact, based on the IQR presented here, less than 25% had 28 days follow-up data to analyze!pic.twitter.com/asI1gDSlEV
Younger people did better than older, people who were not mechanically ventilated did better than those who were (not surprising perhaps)pic.twitter.com/2gHltBjWHt
There were also a large number of reported side-effects, although given the lack of a control group and how sick these people were it's very hard to know if they had anything to do with remdesivirpic.twitter.com/9YS5cmlhxm
As a fun statistical point, the confidence intervals for some of these regression analyses were, uh, pretty wide Older patients had between 35% and 9417% increase risk of death!pic.twitter.com/HMsGPPYXfs
So what does this all mean? Well, the authors talk about it in their discussion Apparently, the mortality rate was lower than expected, which is "noteworthy"pic.twitter.com/VCSblvjbs5
Now, I'd argue that this is...problematic It is extremely difficult to compare patients across trials, and absolutely NOT best practice We also saw a high dropout rate in the trial, with 20% of patients not receiving the complete treatment!https://twitter.com/GidMK/status/1249547200834580485?s=20 …
We also have very few patients in this trial, and no control group Also, the patients were selected by their doctors - perhaps picking the patients that they thought had a fighting chance? We can't really say whether the death rate was low or high from the data we have!
To the author's credit, the final paragraph acknowledges most of this!pic.twitter.com/0TdO2drS1C
Let's sum up:
very small retrospective trial
no control group
written by pharma funder
high dropout
short timeframe
missing data
poorly written/edited
somewhat odd stats
highly selected patient cohort
no causal conclusions!
Basically, it was a very small study with HUGE caveats that showed an interesting possibility Hard to say anything more than that without a proper trial of some kind
Some might argue that this should not have been published as a research trial, given the many caveats and huge conflicts of interest this study seems to contain
I guess that's a question for @NEJM, who appear to have garnered millions of reads on the article in the last few days
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