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rvenkayya's profile
Rajeev Venkayya MD
Rajeev Venkayya MD
Rajeev Venkayya MD
Verified account
@rvenkayya

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Rajeev Venkayya MDVerified account

@rvenkayya

Tackling #Dengue, #COVID, more as head of Takeda Vaccines; CEPI Board member; Fmr White House & Gates Foundation; Pulm & Crit Care; @ucsf @umich; views mine.

Boston, MA
linkedin.com/in/rvenkayya/
Joined July 2013

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    1. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

      Rajeev Venkayya MD Retweeted Helen Branswell

      THREAD There’s much debate around the UK's recommended use of the AZ vaccine with a two-dose schedule and flexible timing of second dose. Some thoughts on the AZ recommendation (not Pfizer) based on available data with refs to some excellent threads. 1/https://twitter.com/HelenBranswell/status/1344306446910058496?s=20 …

      Rajeev Venkayya MD added,

      Helen BranswellVerified account @HelenBranswell
      1. It's a real pity the UK drug regulator, MHRA, doesn't hold public advisory committee meetings to assess #Covid vaccines, in the way @US_FDA does. Would have been fascinating to listen to a detailed analysis of the AstraZeneca-Oxford vaccine's emergency use application. Thread
      Show this thread
      12 replies 153 retweets 306 likes
      Show this thread
    2. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

      Rajeev Venkayya MD Retweeted Dr Ed

      UK’s MHRA and JCVI are highly-experienced in vaccine assessments and recommendations, and they've surely weighed the benefits & risks of this recommendation carefully. That said, it would be good to see all the data underpinning their recommendation. 2/https://twitter.com/notdred/status/1344248984571936768?s=20 …

      Rajeev Venkayya MD added,

      Dr Ed @notdred
      AZ’s new claim is that they achieve 95% efficacy by increasing dose interval to 3 months. I see no efficacy data to support it in the new UK approval but it appears true that immunogenicity is much higher with that regimen (antibody titer nearly 3x higher than short interval) pic.twitter.com/ZtxSPjHUot
      Show this thread
      1 reply 6 retweets 39 likes
      Show this thread
    3. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

      In general, vaccines should be taken on a schedule tested in an efficacy trial. But it wasn’t possible to conduct the typical dose and schedule optimization prior to these Ph3 trials, and those trials provided valuable data to inform these recommendations. 3/

      2 replies 4 retweets 45 likes
      Show this thread
    4. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

      The UK recommends a two-dose schedule, with the second dose between 4-12 weeks. This *is not* a single dose schedule. Given the data provided, and in the setting of limited supply, overstretched hospitals, and emergence of a more transmissible variant, this seems justifiable. 4/

      2 replies 12 retweets 58 likes
      Show this thread
    5. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

      Rajeev Venkayya MD Retweeted Deepti Gurdasani

      The UK has important data on the AZ Vx that wasn’t available for Pfizer & Moderna at FDA's VRBPAC, including: * single-dose efficacy through 4+ months; and * single-dose immunogenicity (12+ weeks). 5/https://twitter.com/dgurdasani1/status/1344727697524740101?s=20 …

      Rajeev Venkayya MD added,

      Deepti Gurdasani @dgurdasani1
      I've been seeing a lot of discussion around the dosage gaps recommended by government for the Astra/Oxford & Pfizer/BioNTech vaccines. My thoughts on the potential benefits & risks of such an approach, and the need for much greater transparency around these decisions. Thread. pic.twitter.com/mclqMDeMQ1
      Show this thread
      1 reply 10 retweets 47 likes
      Show this thread
    6. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

      The data shows the AZ vaccine maintains efficacy in the setting of a delayed second dose, although it’s not clear how fast this wanes over time. Delay of the second dose provides a better booster effect as measured by antibody levels, which is seen with other vaccines. 6/pic.twitter.com/bLtdYhoFqM

      1 reply 7 retweets 49 likes
      Show this thread
    7. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

      Rajeev Venkayya MD Retweeted Sandy Douglas

      The second dose is important because it can drive a more robust and higher quality antibody response through a process called affinity maturation. It's well-understood that longer intervals can provide a better boost. 7/https://twitter.com/sandyddouglas/status/1344949258483621888?s=20 …

      Rajeev Venkayya MD added,

      Sandy Douglas @sandyddouglas
      This issue is, appropriately, contentious. As a vaccinologist - & citizen & relative of people in at-risk groups - I fully support the UK decision to increase dose intervals of both our Ox/AZ product and the Pfizer product. I'd happily receive either with a >8w gap. Here's why 🧵 https://twitter.com/drmarkporter/status/1344926628393181184 …
      Show this thread
      2 replies 5 retweets 46 likes
      Show this thread
      Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

      In my view, the immediate priority is prevention of severe disease that drives deaths and the strain on health systems. Efficacy against severe disease is likely better than overall vaccine efficacy. Data after the first dose is promising although the numbers are small. 8/pic.twitter.com/vxrNPzV4vF

      7:16 AM - 1 Jan 2021
      • 9 Retweets
      • 54 Likes
      • xfedal Stephen Khan astera |-{ Jason B }------- Michael Smith Prof.Dwij Raj Bhatta Judy Stone Ananyo Bhattacharya Yohko Hatada EMLS RI
      1 reply 9 retweets 54 likes
        1. New conversation
        2. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

          There’s nothing magic about the (short) 28d interval between doses, which was presumably chosen to ensure rapid onset of protection in Ph3. Vaccine efficacy won't disappear overnight with a delayed 2nd dose - it will wane over time, if at all. Ph3 data supports that concept. 9/

          1 reply 8 retweets 44 likes
          Show this thread
        3. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

          Yes there are risks of waning immunity, non-compliance with the second dose, confusion among the public, etc. Many are implementation considerations that can be addressed with planning and strong communication. 10/

          2 replies 3 retweets 28 likes
          Show this thread
        4. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

          It will be critically important to collect efficacy data around this “flexible second dose” schedule, esp in older adults & against severe disease, to inform licensure and recommendations in countries around the world that are counting on the introduction of this vaccine. 11/

          2 replies 4 retweets 35 likes
          Show this thread
        5. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

          Yes the AZ/Oxford studies had a number of issues, but we must remember that this highly-complex development program was executed in less than a year. And that Pfizer & Moderna's Ph3 execution & vaccine efficacy created very high expectations for all subsequent programs. 12/

          2 replies 5 retweets 40 likes
          Show this thread
        6. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

          The bottom line is that every country needs to make difficult policy decisions with the data they have, not what they'd like to have. There's no perfect answer here, but now that a decision has been taken, the UK can focus on maximizing the benefit and mitigating any risks. 13/

          11 replies 7 retweets 78 likes
          Show this thread
        7. Rajeev Venkayya MD‏Verified account @rvenkayya 1 Jan 2021

          Rajeev Venkayya MD Retweeted Prof. Akiko Iwasaki

          I didn't address question of adjusting the mRNA vaccine schedule, mainly due to lack of data, and was glad to see @VirusesImmunity posted her expert thoughts on the topic. 14/https://twitter.com/VirusesImmunity/status/1345086669607890945?s=20 …

          Rajeev Venkayya MD added,

          Prof. Akiko IwasakiVerified account @VirusesImmunity
          My first tweet of 2021 is going to be about 1 dose vs. 2 dose vaccine. I have tweeted in the past of the immunological advantages of a 2 dose vaccine. However, given the enhanced transmission variants on the rise, we need a modified strategy. (1/n) https://www.theatlantic.com/science/archive/2020/12/virus-mutation-catastrophe/617531/ …
          Show this thread
          2 replies 6 retweets 48 likes
          Show this thread
        8. End of conversation

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