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0 0.5 1 1.5 2+ Mortality 22% Improvement Relative Risk Goldman et al. HCQ for COVID-19 LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 397 patients in multiple countries Lower mortality with HCQ (not stat. sig., p=0.46) Goldman et al., NEJM, doi:10.1056/NEJMoa2015301 Favors HCQ Favors control
Remdesivir for 5 or 10 Days in Patients with Severe Covid-19
Goldman et al., NEJM, doi:10.1056/NEJMoa2015301
Goldman et al., Remdesivir for 5 or 10 Days in Patients with Severe Covid-19, NEJM, doi:10.1056/NEJMoa2015301
May 2020   Source   PDF  
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Study focused on remdesivir but with results for HCQ in the supplementary appendix, showing 9% death with HCQ versus 12% control, unadjusted relative risk uRR 0.78, p = 0.46.
Although the 22% lower mortality is not statistically significant, it is consistent with the significant 22% lower mortality [18‑27%] from meta analysis of the 232 mortality results to date. This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.
risk of death, 22.3% lower, RR 0.78, p = 0.46, treatment 10 of 109 (9.2%), control 34 of 288 (11.8%), NNT 38.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Goldman et al., 27 May 2020, retrospective, multiple countries, peer-reviewed, 26 authors.
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Abstract: The n e w e ng l a n d j o u r na l of m e dic i n e Original Article Remdesivir for 5 or 10 Days in Patients with Severe Covid-19 Jason D. Goldman, M.D., M.P.H., David C.B. Lye, M.B., B.S., David S. Hui, M.D., Kristen M. Marks, M.D., Raffaele Bruno, M.D., Rocio Montejano, M.D., Christoph D. Spinner, M.D., Massimo Galli, M.D., Mi‑Young Ahn, M.D., Ronald G. Nahass, M.D., Yao‑Shen Chen, M.D., Devi SenGupta, M.D., Robert H. Hyland, D.Phil., Anu O. Osinusi, M.D., Huyen Cao, M.D., Christiana Blair, M.S., Xuelian Wei, Ph.D., Anuj Gaggar, M.D., Ph.D., Diana M. Brainard, M.D., William J. Towner, M.D., Jose Muñoz, M.D., Kathleen M. Mullane, D.O., Pharm.D., Francisco M. Marty, M.D., Karen T. Tashima, M.D., George Diaz, M.D., and Aruna Subramanian, M.D., for the GS-US-540-5773 Investigators*​​ A BS T R AC T BACKGROUND Remdesivir is an RNA polymerase inhibitor with potent antiviral activity in vitro and efficacy in animal models of coronavirus disease 2019 (Covid-19). METHODS We conducted a randomized, open-label, phase 3 trial involving hospitalized patients with confirmed SARS-CoV-2 infection, oxygen saturation of 94% or less while they were breathing ambient air, and radiologic evidence of pneumonia. Patients were randomly assigned in a 1:1 ratio to receive intravenous remdesivir for either 5 days or 10 days. All patients received 200 mg of remdesivir on day 1 and 100 mg once daily on subsequent days. The primary end point was clinical status on day 14, assessed on a 7-point ordinal scale. The authors’ affiliations are listed in the Appendix. Address reprint requests to Dr. Brainard at Gilead Sciences, 333 Lakeside Dr., Foster City, CA 94404, or at ­diana​.­brainard@​­gilead​.­com. *A list of investigators in the GS-US-5405773 trial is provided in the Supplementary Appendix, available at This article was published on May 27, 2020, at N Engl J Med 2020;383:1827-37. DOI: 10.1056/NEJMoa2015301 Copyright © 2020 Massachusetts Medical Society. RESULTS In total, 397 patients underwent randomization and began treatment (200 patients for 5 days and 197 for 10 days). The median duration of treatment was 5 days (interquartile range, 5 to 5) in the 5-day group and 9 days (interquartile range, 5 to 10) in the 10-day group. At baseline, patients randomly assigned to the 10-day group had significantly worse clinical status than those assigned to the 5-day group (P = 0.02). By day 14, a clinical improvement of 2 points or more on the ordinal scale occurred in 64% of patients in the 5-day group and in 54% in the 10-day group. After adjustment for baseline clinical status, patients in the 10-day group had a distribution in clinical status at day 14 that was similar to that among patients in the 5-day group (P = 0.14). The most common adverse events were nausea (9% of patients), worsening respiratory failure (8%), elevated alanine aminotransferase level (7%), and constipation (7%). CONCLUSIONS In patients with severe Covid-19 not requiring mechanical ventilation, our trial did not show a significant difference between a 5-day course and a 10-day course of remdesivir. With no placebo control, however, the magnitude of benefit cannot be determined. (Funded by Gilead Sciences; GS-US-540-5773 number, NCT04292899.) n engl j med 383;19 November 5, 2020 The New England Journal of Medicine Copyright © 2020..
Late treatment
is less effective
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