COVID treatments
For the first time, there’s data from a reasonably large randomised trial of a COVID-19 treatment: a drug called remdesivir. And it’s modestly good news. People in hospital, with lower respiratory tract symptoms were randomly assigned to remdesivir or placebo, and those given remdesivir recovered faster, and more of them recovered in 30 days — in the sense that they were healthy enough to leave hospital. There wasn’t definitive evidence on the proportion dying, though there were fewer deaths in the remdesivir group. The treatment didn’t seem to do much for people who were already on ventilators, but it’s hard to be sure about subgroups when the whole trial is only just big enough to give convincing results. The improvement wasn’t massive (25-30% better), but it does look real, which is encouraging for other drugs that work the same way, as well as for future patients.
It turns out that I know the statistician who did the main analysis (Hi, Lori!), and who must have had an incredibly stressful couple of months (especially after the basic trend was publicised by Dr Fauci a month ago).
Update: the following study is now looking really, really dubious, so perhaps don’t bother reading about it.
There’s also data from another large observational study of chloroquine. It’s from a collection of hospitals around the world who kept registers of who got what treatment (even though it wasn’t randomly allocated). This paper looks at 96000 people who were treated early (less than two days after diagnosis) and who were not on ventilators. There’s no suggestion of a benefit of chloroquine or hydroxychloroquine: in fact, patients getting either drug, with or without an antibiotic like azithromycin, did worse.
The paper ends with a ritual invocation “These findings suggest that these drug regimens should not be used outside of clinical trials and urgent confirmation from randomised clinical trials is needed.” It’s getting towards the point where confirmation from randomised trials really isn’t needed any more.
Thomas Lumley (@tslumley) is Professor of Biostatistics at the University of Auckland. His research interests include semiparametric models, survey sampling, statistical computing, foundations of statistics, and whatever methodological problems his medical collaborators come up with. He also blogs at Biased and Inefficient See all posts by Thomas Lumley »
Wasnt Trump using chloroquine not as a treatment but as a preventer or prophylactic ?
It seems to have become common for the worried well, that countries that have a centralised drug buying agency like NZ and Australia have limited access, but Im not even sure how they do a proper trial in the current circumstances.
4 years ago
There’s also reasonably good observational evidence that it doesn’t work as a prophylactic, from comparing the rates of COVID infection in rheumatoid arthritis patients who take it vs taking some alternative drug.
There actually is an NZ trial in healthcare workers, funded by HRC, that’s waiting to run if there is a big outbreak here. I’m not convinced that it will be the most important comparison by then.
4 years ago