A large, well-done observational trial just found a big mortality benefit for ondansetron in the treatment of COVID-19 I think this is a fascinating case study in how we use observational researchhttps://academic.oup.com/ofid/article/8/7/ofab336/6320906?searchresult=1#275722395 …
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The main conclusion is that we should probably try ondasetron as a treatment for COVID-19 in RCTs, which I think is justifiable based on the studypic.twitter.com/FbEVJINeEB
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But I think the really interesting part is the initial analysis. It looks like if you test 84 medications for benefit in COVID-19 mortality, 6 positive results will be foundpic.twitter.com/ey7ccuB7si
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Thing is, we've been using studies a LOT worse than this one to drive treatments for the whole pandemic. The initial use of ivermectin, HCQ etc in 2020 was based on much less robust evidence than this research
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Why is this interesting? I think it shows just how important RCTs of interventions for COVID-19 are If you test a bunch of drugs, you'll see some positives
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If 1,000 people run studies on their databases, and you only really see the positive results published, you'll get the false impression that these drugs work against coronavirus even when the evidence is not good at all
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This is in no way a critique of this specific paper, whose authors appear to have done a fantastic job, but it is a pretty worrying note for the rest of us
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Anyway, ondansetron is a cheap, low-side-effect drug available pretty much everywhere in the world, so if it works for COVID-19 it'd be a brilliant addition to the arsenal
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