And here’s the Lancet study from China showing no mortality benefit from remdesivir:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext?utm_campaign=tlcoronavirus20&utm_source=twitter&utm_medium=social …
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You’ll notice the NIH study...also doesn’t show a statistically significant mortality benefit for remdesivir!!
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As
@MarkHoofnagle pointed out, remdesivir is supposed to work via viral replication inhibition; it prevents RNA viruses from copying their genetic material.1 reply 0 retweets 12 likesShow this thread -
This means a trial on advanced
#COVID19 patients was never gonna tell us jack shit. Viral load in this disease peaks around the onset of symptoms!!3 replies 0 retweets 22 likesShow this thread -
If your drug works by killing virus or blocking it from replicating, you’ve got to test it on *brand new* cases!
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(Mea culpa; I could have known this trial was gonna suck before the results came out, based on trial design, but I didn’t check.)
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Look; this means *mechanism is bullshit*. An antiviral that “works” but doesn’t decrease viral load? Sure, I guess, it can have a different mechanism, but given how often this happens, should we really be framing drugs as having “known” MOAs at all?
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Replying to @s_r_constantin
I was/am also puzzled by the viral load data but i think it’s worth entertaining the possibility that viral RNA as measured in the respiratory tract may not be the best measure for these patients. In the rhesus macaque remdesivir study, the effect on swab results was also null...
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Replying to @LucreSnooker @s_r_constantin
but viral RNA and infectivity in lung samples did seem meaningfully different, and the animals seemed less sick. So one possible model is — immune system is pretty good at getting rid of virus in nose/throat but in the lungs a combination of virus- and immune-mediated damage...
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Replying to @LucreSnooker @s_r_constantin
allow the virus to spread more broadly via the blood (e.g. to kidneys, maybe even brain). If this requires damage it may be slower to take place. So the hypothesis is then that if you measured viral load in lungs or blood you’d see something. Maybe.
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Replying to @s_r_constantin
Lucre Snooker Retweeted Lucre Snooker
thread of me thinking out loud about this: https://twitter.com/lucresnooker/status/1253802900893184001?s=21 …https://twitter.com/LucreSnooker/status/1253802900893184001 …
Lucre Snooker added,
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