[BostonCard]

The preprint paper is out:

https://www.medrxiv.org/content/10.1101/...1.full.pdf

With the caveat that it hasn't been peer reviewed, the mortality data for remdisivir looks very negative.  Not even a trend towards an improvement.  The figure on Page 15, with the two curves on top of one another, tells the story.

The authors also did a meta analysis for mortality (figure 4), incorporating all of the remdisivir studies (there have been four with reported data: Solidarity (this one) ACTT, and two smaller ones).  There might be a small benefit in low risk groups, but things look, if anything, worse in the high risk groups.

There are4 trials of Remdesivir vs the same management without it: Solidarity (604 deaths in about 5000 randomized), ACTT-1 (136 deaths in about 1000) and two smaller trials (41 deaths).5-7 Figure 4 gives mortality results from each trial, subdivided by initial respiratory support. (These like-vs-like comparisonsallow for the proportion already on high-flow oxygen or ventilation at entry into ACTT-1 having been, by chance, somewhat lower with Remdesivir than with placebo.)  Combining dataappropriatelyfrom all 4 trials,8the Remdesivir vs control death rate ratio (RR) is 0.91 (95% CI 0.79-1.05).Interpretation should chiefly reflect not the p-value (p=0.21) or point estimate (RR=0.91) but the confidence interval (0.79-1.05), which shows the range of death rate ratios comfortably compatible with the weighted average of the findings from all trials. This absolutely excludes the suggestion that Remdesivir can prevent a substantial fraction of all deaths. The confidence interval is comfortably compatible with prevention of a small fraction of all deaths, but is also comfortably compatible with prevention of no deaths (which would be consistent with the apparent lack of any reduction by Remdesivir in the initiation of ventilation or the duration of hospitalization in Solidarity).

I'll translate: we can't completely exclude an effect, but if there, it is pretty small.

BC

[BostonCard]

The preprint paper is out:

https://www.medrxiv.org/content/10.1101/...1.full.pdf

With the caveat that it hasn't been peer reviewed, the mortality data for remdisivir looks very negative.  Not even a trend towards an improvement.  The figure on Page 15, with the two curves on top of one another, tells the story.

The authors also did a meta analysis for mortality (figure 4), incorporating all of the remdisivir studies (there have been four with reported data: Solidarity (this one) ACTT, and two smaller ones).  There might be a small benefit in low risk groups, but things look, if anything, worse in the high risk groups.

There are4 trials of Remdesivir vs the same management without it: Solidarity (604 deaths in about 5000 randomized), ACTT-1 (136 deaths in about 1000) and two smaller trials (41 deaths).5-7 Figure 4 gives mortality results from each trial, subdivided by initial respiratory support. (These like-vs-like comparisonsallow for the proportion already on high-flow oxygen or ventilation at entry into ACTT-1 having been, by chance, somewhat lower with Remdesivir than with placebo.)  Combining dataappropriatelyfrom all 4 trials,8the Remdesivir vs control death rate ratio (RR) is 0.91 (95% CI 0.79-1.05).Interpretation should chiefly reflect not the p-value (p=0.21) or point estimate (RR=0.91) but the confidence interval (0.79-1.05), which shows the range of death rate ratios comfortably compatible with the weighted average of the findings from all trials. This absolutely excludes the suggestion that Remdesivir can prevent a substantial fraction of all deaths. The confidence interval is comfortably compatible with prevention of a small fraction of all deaths, but is also comfortably compatible with prevention of no deaths (which would be consistent with the apparent lack of any reduction by Remdesivir in the initiation of ventilation or the duration of hospitalization in Solidarity).

I'll translate: we can't completely exclude an effect, but if there, it is pretty small.

BC