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zeynep's profile
zeynep tufekci
zeynep tufekci
zeynep tufekci
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zeynep tufekciVerified account

@zeynep

Complex systems, wicked problems. Society, technology, science and more. @UNC professor. @NYTimes columnist. My newsletter is @insight: http://www.theinsight.org 

floating in a most peculiar way
theinsight.org
Joined August 2009

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    1. Lauring Lab‏ @LauringLab 6 Dec 2021

      We also know that mutated viruses can sometimes interfere with unumutated ones through a process called "lethal defection." Here these mutated viruses run interference and gum up the replication machinery. This limits replication of sub-lethally mutated viruss. (17/x)

      2 replies 3 retweets 72 likes
      Show this thread
    2. Lauring Lab‏ @LauringLab 6 Dec 2021

      Some other things that are also IMO overlooked in discussion of molnupiravir. Another drug, favirpiravir, works in a similar manner, and has been used for influenza in other countries. So there's experience here. (18/x)

      1 reply 3 retweets 72 likes
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    3. Lauring Lab‏ @LauringLab 6 Dec 2021

      See this from @cjriIllingworth on immunocompromised host with favirpiravir (in combination). (19/x)https://pubmed.ncbi.nlm.nih.gov/32124919/ 

      1 reply 3 retweets 46 likes
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    4. Lauring Lab‏ @LauringLab 6 Dec 2021

      I suspect that many clinicians may choose to use molnupiravir in combination in immunocompromised hosts btw. (20/x)

      1 reply 1 retweet 46 likes
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    5. Lauring Lab‏ @LauringLab 6 Dec 2021

      It's really hard to predict evolution - and the evolutionary impacts of drugs and vaccines. The discussion of molnupiravir reminds me a bit of the discussion about delayed vax second dose in early 2021 and whether that would lead to selection of variants. (21/x)

      3 replies 4 retweets 69 likes
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    6. Lauring Lab‏ @LauringLab 6 Dec 2021

      There were theoretical risks, but also theoretical benefits. There were data from other viruses. The lessons from that experience are that evolution is complicated and that it's hard to capture all the upsides and downsides of an intervention like a drug or vaccine. (22/x)

      2 replies 5 retweets 75 likes
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    7. Lauring Lab‏ @LauringLab 6 Dec 2021

      So, conclusions. 1. Great thread from @CT_Bergstrom 2. There's more to molnupiravir than is getting discussed 3. I wish data were better, but think there's a place for it 4. We need to better define the risk of sublethal mutagenesis and variant generation. (23/x)

      4 replies 20 retweets 157 likes
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    8. Lauring Lab‏ @LauringLab 6 Dec 2021

      5. Right now, largely theoretical. Need more data. Fin! (24/24)

      13 replies 5 retweets 110 likes
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    9. zeynep tufekci‏Verified account @zeynep 6 Dec 2021
      Replying to @LauringLab

      Question: Would this not suggest more data should be collected before approval? Especially given the benefit itself is under question? (Zero efficacy in second half looks like regression to the mean). Patient compliance certainly an issue with an at-home five days every 12h pill.

      1 reply 0 retweets 5 likes
    10. Lauring Lab‏ @LauringLab 6 Dec 2021
      Replying to @zeynep

      Not necessarily. There's always post-approval data collection. FDA panel has evaluated risks and benefits from initial data. It's a question of whether you think FDA evaluation was adequate and appropriate.

      2 replies 0 retweets 1 like
      zeynep tufekci‏Verified account @zeynep 6 Dec 2021
      Replying to @LauringLab

      Right, though FDA panel is advisory, the vote barely squeaked by, multiple no voters mentioned this and no approval yet. So question is what should the FDA do? The usual risk/benefit or adverse/event framework doesn't seem suited for this. Risk is to planet, not to patient. 1/2

      7:12 AM - 6 Dec 2021
      • 3 Likes
      • Chase W. Nelson 倪誠志 Michael Lin, MD PhD 🧬 madeupmasters
      2 replies 0 retweets 3 likes
        1. zeynep tufekci‏Verified account @zeynep 6 Dec 2021
          Replying to @zeynep @LauringLab

          FDA presumably could ask for more data (especially since the efficacy in the second half seems so weird—zero benefit?) before approving rather than plunge into tail risk (as you note: theoretical, of course, not studied enough) since it's about more than individual patients. 2/2

          0 replies 0 retweets 2 likes
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        2. Lauring Lab‏ @LauringLab 6 Dec 2021
          Replying to @zeynep

          Maybe I'm overly naive, but the FDA will do what FDA always does...look at the data, consider input of their advisory panel and their internal experts, and make a decision. If approved, hospitals and physician groups will make guidelines about when to use it and how.

          1 reply 0 retweets 0 likes
        3. Michael Lin, MD PhD  🧬‏ @michaelzlin 6 Dec 2021
          Replying to @LauringLab @zeynep

          Problem is FDA isn't tasked with thinking about effects of viral mutations beyond those people taking it. FDA might think people taking it will benefit* more than they are harmed, so approve. *but by just 30% in avoiding the hospital, which is just ~3% of the indicated pt pool.

          0 replies 0 retweets 0 likes
        4. End of conversation

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