What your doctor is reading on Medscape.com:
MAY 18, 2020 — Since March 25, two HIV clinical fellows, Eric Meyerowitz, MD, and Aaron Richterman, MD, MPH, have recorded a biweekly deep dive into the most compelling COVID-19 data. Their presentations have become “must-see” TV (or rather, YouTube) for those trying to make sense of all the pandemic-related literature.
Medscape asked them to summarize what they’ve learned so far, ahead of their next update, scheduled for May 19.
Below are key takeaways from our fourth update, covering April 23 to May 5, during which more than 3000 COVID-related papers were published on PubMed and another 766 were released in preprint form:
Remdesivir: A small, underpowered study in China found no difference in 28-day clinical improvement or mortality, in contrast to as-yet unpublished data from a larger NIAID study.
The benefit of IL-6 inhibitor therapy is unknown; multiple randomized controlled trials (RCTs) are ongoing.
Early studies suggested that viral RNA was rarely found in the blood. Now viremia/RNAemia with extrapulmonary infection is becoming more characterized, but it’s still not clear whether it represents systemic infection with infectious virus.
It’s currently unknown what proportion of patients have a viremic phase of illness.
The association between thrombosis and COVID-19 is becoming clearer, but the benefit of changing evidence-based anticoagulation strategies is unknown.
Structural inequities around racism and impoverishment are associated with differential outcomes, and more data are urgently needed.
Nonpharmaceutical interventions are important for epidemic control and economic recovery.
COVID-19 Therapy Randomized Trials
We summarized the major RCTs on COVID-19 therapeutics for which we have full papers (some in preprint form) (Table 1).
Table 1. Major COVID-19 Randomized Treatment Trials to Date
Clinical improvement, mortality, and percentage of patients with detectable viral RNA similar; median of 13 days from illness onset to randomization
Favipiravir versus umifenovir
For patients with moderate COVID, favipravir led to faster day 7 clinical recovery and resolution of fevers but no difference in need for mechanical ventilation
Primary outcome of viral clearance at 28 days may not be a good endpoint; randomized late in illness course
Lopinavir/ritonavir versus umifenovir versus control
No difference for primary or secondary outcomes
Randomized 2:2:1; open-label trial with relatively small N; primary endpoint was time to negative RT-PCR, which may not be meaningful
No difference in primary outcome; trend toward mortality improvement for those started within 10 days of symptom onset
Outbreak controlled in Wuhan before prespecified enrollment goal could be met: underpowered; majority of patients received steroids in this cohort
We also discussed additional therapeutic data from press releases (Table 2).
Table 2. Preliminary Data on COVID-19 Randomized Treatment Trials
Remdesivir group: 31% faster recovery compared with placebo; trend toward improved mortality
Preliminary report of findings based on press release; formal report pending peer review
Similar improvement in severe-disease patients who received 5 or 10 days of remdesivir
Industry-sponsored trial (Gilead);