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Gilead signed a billion dollar deal with the EU Commission for Remdesivir on the 8 October. However, Gilead apparently received the WHO study on 28 September a

Gilead signed a billion dollar deal with the EU Commission for Remdesivir on the 8 October. However, Gilead apparently received the WHO study on 28 September and so were aware of the conclusions of the study before they signed a deal with the EU Commission. This naturally leads to further questions, as discussed in this tweet thread: https://twitter.com/kakape/status/1317042940825436162 https://twitter.com/kakape/status/1317042940825436162 Edit: Martin Landray, professor of medicine and epidemiology at the University of Oxford and leader of the UK-based Recovery trial also has a good summary of the WHO trial: https://twitter.com/MartinLandray/status/1316989951297396736 https://twitter.com/MartinLandray/status/1316989951297396736

ucha 6y ago
Martin Landry: "People will argue about the need for earlier use (possibly) or that with even more data there may be a benefit (possibly - but where are those trials going to come from). But the effect is modest at best - and so far there is no strong evidence it is there at all." But it doesn't follow at all that because there is no effect when administered late, the effect, if administered early, is modest as best. In fact, there are many medication that are very effective if administered before the first symptoms appear and are completely useless after. If you get exposed to rabies, you can get a rabies vaccine and have close to no chance of contracting it, whereas if you get a vaccine after you develop symptoms, you're almost certain to die. Similarly, the flu antivirals are somewhat helpful if taken early but have no effect if taken too late.
- m0zg 6y ago
  It's as if they're doing this on purpose. It is quite obviously pointless to administer antiviral drugs _after_ the cytokine storm sets in and the person is already dying.
- vanilla-almond 6y ago
  Landray says in the same twitter thread: "...Remdesevir is given by intravenous infusion for 5-10 days. It is not cheap. And supplies are limited (not surprising given scale of epidemic)." This means anyone showing early symptoms is likely to require a stay in hospital for early administration of the intravenous infusion. There are questions about how scalable this is. Landray again: "COVID affects millions of people & their families around the world. It is not a rare disease and we need scalable, affordable, and equitable treatment solutions."
  - lbeltrame 6y ago
    Gilead was said to be working on an inhaled version (it can't be administered orally, because it is completely destroyed in the liver).
rsynnott 6y ago
I'm not sure that anyone ever _really_ thought it improved survival. Just cutting time in hospital would be useful enough.
- boomboomsubban 6y ago
  You generally spend time in the hospital when your condition is critical. So, if it cut hospital time, it would improve survival.
  - petemir 6y ago
    Or kill you faster.
  - recursive 6y ago
    Dead people don't spend time in the hospital. Therefore, being dead improves survival.
    - boomboomsubban 6y ago
      I assume they track hospital time by the discharge date, the deceased would be classified separately.
      - recursive 6y ago
        I'm not making any assumptions.
        boomboomsubban 6y ago
        I don't understand what you're doing. For more clarity, I'll change my statement to >So, unless you die, if it cut hospital time, it would improve survival.
        madacol 6y ago
        That doesn't makes sense to me, it can make recoveries faster, while still making dying faster or slower, and still have the same mortality. They are all independent consequences
zobzu 6y ago
Medicine is definitely politics when its uncertain how much certain drugs really help. One the one hand you could say: WHO has an unreviewed study that says "china early vaccine tests good, usa drug bad" and Gilead has a bunch of studies that say usa drug good. On the other hand you could say: the studies wording is so fine tune that its hard to say if any are true. Results: - some side with their political/religious beliefs (and will downvote this probably) - some are confused about what is true and admit they just don't know (I'm definitely there) - some are a bit of both

ucha 6y ago

Martin Landry: "People will argue about the need for earlier use (possibly) or that with even more data there may be a benefit (possibly - but where are those trials going to come from). But the effect is modest at best - and so far there is no strong evidence it is there at all." But it doesn't follow at all that because there is no effect when administered late, the effect, if administered early, is modest as best. In fact, there are many medication that are very effective if administered before the first symptoms appear and are completely useless after. If you get exposed to rabies, you can get a rabies vaccine and have close to no chance of contracting it, whereas if you get a vaccine after you develop symptoms, you're almost certain to die. Similarly, the flu antivirals are somewhat helpful if taken early but have no effect if taken too late.

m0zg 6y ago
It's as if they're doing this on purpose. It is quite obviously pointless to administer antiviral drugs _after_ the cytokine storm sets in and the person is already dying.
vanilla-almond 6y ago
Landray says in the same twitter thread: "...Remdesevir is given by intravenous infusion for 5-10 days. It is not cheap. And supplies are limited (not surprising given scale of epidemic)." This means anyone showing early symptoms is likely to require a stay in hospital for early administration of the intravenous infusion. There are questions about how scalable this is. Landray again: "COVID affects millions of people & their families around the world. It is not a rare disease and we need scalable, affordable, and equitable treatment solutions."
- lbeltrame 6y ago
  Gilead was said to be working on an inhaled version (it can't be administered orally, because it is completely destroyed in the liver).

rsynnott 6y ago

I'm not sure that anyone ever _really_ thought it improved survival. Just cutting time in hospital would be useful enough.

boomboomsubban 6y ago
You generally spend time in the hospital when your condition is critical. So, if it cut hospital time, it would improve survival.
- petemir 6y ago
  Or kill you faster.
- recursive 6y ago
  Dead people don't spend time in the hospital. Therefore, being dead improves survival.
  - boomboomsubban 6y ago
    I assume they track hospital time by the discharge date, the deceased would be classified separately.
    - recursive 6y ago
      I'm not making any assumptions.
      - boomboomsubban 6y ago
        I don't understand what you're doing. For more clarity, I'll change my statement to >So, unless you die, if it cut hospital time, it would improve survival.
        madacol 6y ago
        That doesn't makes sense to me, it can make recoveries faster, while still making dying faster or slower, and still have the same mortality. They are all independent consequences

zobzu 6y ago

Medicine is definitely politics when its uncertain how much certain drugs really help. One the one hand you could say: WHO has an unreviewed study that says "china early vaccine tests good, usa drug bad" and Gilead has a bunch of studies that say usa drug good. On the other hand you could say: the studies wording is so fine tune that its hard to say if any are true. Results: - some side with their political/religious beliefs (and will downvote this probably) - some are confused about what is true and admit they just don't know (I'm definitely there) - some are a bit of both