3/n So, if you only glance at the abstract, you get the picture of an amazing positive result for vitamin D But reading further, the problems start almost immediately
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14/n There's more. If this WAS indeed a cluster RCT (I'm skeptical), then the authors did the wrong analysis and the results are probably actually non-significant Excellent thread here:https://twitter.com/lycraolaoghaire/status/1360765704849481731?s=20 …
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15/n There are also numerous issues I haven't covered that
@fperrywilson does a great job dissecting here:https://twitter.com/fperrywilson/status/1360944814271979523?s=20 …Show this thread -
16/n There are other odd inconsistencies with the study. For example, they had 93 patients die and 110 ICU admissions That's a startlingly high ICU mortality rate, unless a majority of patients who died were not admitted to ICU
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17/n For some context, the average ICU mortality was about 30% in Spain at the time, which is still really high but not "almost 100%" highhttps://www.sciencedirect.com/science/article/abs/pii/S2341192920300986 …
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18/n The timelines are really weird. The study is reported as going for 91 days (1st March-31st May) but the K-M curves have 100 days for the treatment group. Probably a minor error, but still strangepic.twitter.com/SH9NKeiVgG
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19/n The K-M curves are also just bizarre. My guess is that they've confused the outcome death with the inverse for the second graph, but even then they really make little sense
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20/n Also, the study ran until May 31st. This magnificent, amazing, literally earth-shattering result (60% REDUCTION IN MORTALITY) took...8 months? And no news, barely any press, for a treatment that could save 60% of people with COVID-19?pic.twitter.com/UEwDfFLqB3
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21/n The study also wasn't pre-registered, which is an issue considering it started on March 1st 2020. When was the treatment protocol (HCQ+azithro and dexamethasone) decided on?pic.twitter.com/sRvMutWu9k
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22/n Also, how in the world did one relatively modest-sized hospital have 8 fully-dedicated COVID-19 wards open in Barcelona, at a time when Spain itself only had a handful of COVID-19 cases? Any Barcelonian followers who can elaborate?
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23/n The same author group wrote another paper on the same patient population in January. Why was there no mention of this trial, or the MASSIVE mortality reduction anywhere? None of this is necessarily disqualifying, it's just really odd!pic.twitter.com/n6J8ihD9S3
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24/n I should specify that none of this makes the study totally sketchy, it's just all really weird and they are things that the authors should have explained in the paper
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25/n Overall, what we have is a study that, if run as specified, was a non-randomized prospective cohort study that gives us very little/no new information on vitamin D for COVID-19
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26/n This doesn't mean that you shouldn't take vitamin D, it's relatively low-cost and the harm is mostly to your wallet, but the jury is still out whether it will have any benefit at all to COVID-19
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27/n Update: the authors have confirmed that this was not a randomized trial on PubPeer. They are still using the word "random" in a very confusing way, but what is described here is not an RCT by any descriptionpic.twitter.com/epHN075OA7
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28/n And I wrote a piece about this trial and COVID-19 and vitamin D in generalhttps://gidmk.medium.com/vitamin-d-and-covid-19-an-update-59fb2f9cceb5 …
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End of conversation
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