Dexamethasone saves lives in COVID-19. RECOVERY trial shows dexamethasone decreases risk of death in those needing oxygen by 20%, and by 35% in those on a ventilator. On the shelf, cheap and can be taken by everyone - a real breakthrough.
RECOVERY trial result: in COVID patients with low oxygen and inflammation, tocilizumab saves lives, keeps you off a ventilator, and gets you out of hospital quicker.
Enormous thanks to the thousands of NHS staff and patients who made this possible.
Pre-print coming very soon.
The RECOVERY Data Monitoring Committee reviewed data on patients randomised to convalescent plasma vs. usual care. The preliminary analysis based on 10,406 randomised patients with 1873 reported deaths shows no significant difference in the primary endpoint of 28-day mortality.
⏩ New RECOVERY trial result.
Monoclonal antibody combination reduces deaths in seronegative patients hospitalised with COVID-19.
- 9785 patients randomised
- primary analysis population 3153 patients without own SARS-CoV2 antibodies detectable at randomisation (seronegative)
Covid-19: Oxford University vaccine shows 70% protection. Oxford jab is far cheaper, and is easier to store and get to every corner of the world than the other two.
I’m immensely proud to be leading the new Pandemic Sciences Centre
@UniofOxford
The global scientific community have delivered huge societal benefits during the COVID pandemic.
Our aspiration is to apply that same energy and innovation to prevent this ever happening again.
🆕 | Oxford University announces the launch of a new centre of global research collaboration and excellence, the Pandemic Sciences Centre.
The centre's mission will be to ensure that the world is better equipped to identify and counter future pandemic threats.
RECOVERY Update
- colchicine added today
- still studying aspirin, convalescent plasma, REGN-CoV2, and tocilizumab
- just passed 19,000 patients enrolled.
Thank you everyone who has made this possible. Incredible effort that will soon give us more robust results.
Results of DisCoVeRy trial of remdesivir in COVID now out. No significant effect of remdesivir on death, other clinical outcomes or viral kinetics. Big question about the role of this drug.
Carl Henengans says "'I've been doing this job for 25 years and I can tell you can't establish a quantifiable number in such a short time frame." Yes you can. Prof Henengans has not been doing phylogenetic and mathematical modelling of infectious disease dynamics for 25 years.
New RECOVERY result. In patients hospitalised with COVID-19, azithromycin did not provide any clinical benefit. 28 day mortality (19% vs 19%) (rate ratio 1·00; 95% confidence interval [CI] 0·90-1·12; p=0·99). No effect on secondary outcomes either.
New RECOVERY result: Baricitinib
8156 patients randomly allocated to receive usual care plus baricitinib versus usual care alone.
28-day mortality lower in patients allocated baricitinib: 513/4148 (12%) vs 546/4008 (14%) (age-adjusted rate ratio 0.87; 95% CI 0.77-0.98; p=0.026)
RECOVERY publication on hydroxychloroquine finally out. Hydroxychloroquine is not effective in hospitalised COVID patients. Disappointing, but allows us to focus our efforts on promising new treatments.
Full results of RECOVERY convalescent plasma trial now available.
-11,558 hospitalised patients randomised
-5,795 allocated to high-titre plasma
-Sadly, we no saw no clinical benefits
Great news: REGEN-COV2 monoclonal antibody cocktail to be tested in RECOVERY. High SARS-COV-2 viral load is associated with worse clinical outcomes, so thrilled to be testing this potent antiviral. Lancet Respir Med. 2020 Sep;8(9):e70. Science 2020;369:1010-1014
Potential health and economic impacts of dexamethasone treatment for patients with COVID-19
Between July and December 2020, dexamethasone is estimated to have saved 12,000 (4,250 - 27,000) lives in the UK and 650,000 (240,000 - 1,400,000) globally.
Dexamethasone reduced deaths by 1/3rd in ventilated patients (rate ratio 0.65 [95% CI 0.48 to 0.88]; p=0.0003) and by 1/5th in patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). No benefit in patients not requiring respiratory support (1.22 [0.86 to 1.75; p=0.14).
So a treatment for hospitalised COVID-19 patients who require respiratory support. Globally, a lot of lives will be saved. Hugely indebted to all the patients, relatives and NHS workers who made this possible.
This is not an "inevitable seasonal surge in Covid and other respiratory pathogens".
1. It is summer in South Africa. As many places, SA has had both summer and winter waves. Seasonal influence on non-endemic infections is weak
🎂Today is exactly one year since we randomised the first patient to the RECOVERY trial - 19th March 2020.
An astonishing contribution to global health by thousands of NHS and NIHR staff, and tens of thousands of patients.
Join our anniversary webinar on 7th April.
RECOVERY closes colchicine arm - no benefit in hospitalised COVID patients.
Disappointing, but nevertheless it advances our care of COVID patients. Full results to follow ASAP.
Still testing aspirin, MAb, baricitinib
Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY).
In patients admitted to hospital with COVID-19, azithromycin did not improve survival or other prespecified clinical outcomes.
Monkeypox epidemiology - is the simultaneous detection of multiple cases in multiple locations more consistent with dispersion from a single super-spreading event (such as a festival), or from multiple unrecognised chains of community transmission?
1/ As unbelievable as it sounds, it appears the RECOVERY trial confused hydroxy*chloroquine* (HCQ) w/ the drug class hydroxy*quinolines*
The investigators of RECOVERY said they based HCQ dosing off treatment of amoebic dysentery, which is why they decided 2,400mg of HCQ on day 1
Hydroxychloroquine and chloroquine should not be used to treat hospitalised COVID patients.
Meta-analysis of 14 unpublished trials (1308 patients) and 14 publications/preprints (9011 patients).
Pre-print now out.
Effect of Hydroxychloroquine in Hospitalized Patients with COVID-19: Preliminary results from a multi-centre, randomized, controlled trial.
🔥 RECOVERY result Aspirin
14892 COVID patients randomised to aspirin vs. usual care alone - no significant difference in 28-day mortality (17% aspirin vs. 17% usual care; rate ratio 0.96 [95% CI 0.89-1.04]; p=0.35). Pre-print imminent.
RECOVERY pre-print out.
In hypoxic hospitalised COVID-19 patients requiring either no oxygen or simple oxygen only, higher dose corticosteroids significantly increased the risk of death compared to usual care, which included low dose corticosteroids.
RECOVERY had all three:
1. All plasma tested with an assay ≥ 99% sens and spec for SARS-CoV-2 Abs
2. No mortality benefit in patients allocated to CP ≤4 days from illness onset (n=1908).
3. All plasma units far exceeded FDA definition of "high titre"
Sadly not a scientific win. Many of the early trials including RECOVERY were not designed taking into account 100 years of experience with antibody therapies - see
Of the principles recovery had 1, maybe 3, but not 2
Amy, push on with confidence. I got BCD (yes D!) A level grades. Not what I needed from the lowest offer I got; but doctor I am, professor now @ Oxford.
I tell you one thing. Yes I didn’t get the grades I want, and yes I did get rejected from both my firm and insurance choices. But there is nothing stopping me from becoming a doctor some day
Results of SOLIDARITY trial now published in NEJM. Remarkable achievement, with clear, albeit disappointing, results. Challenging to find an effective antiviral against SARS-CoV-2.
If Legionella is confirmed as the cause of the pneumonia cases in Argentina, this is good news for public health. Common organism, common to see outbreaks, not more than a localised threat, treatable, and we know how to neutralise the source.
Argentina health department confirmed the ‘unknown pathogen’ of the pneumonia cases as Legionela pneumonia bacteria today. Fast action and transparency to fight outbreaks. Genomes should follow in the next few days 🇦🇷
RECOVERY trial goes international.
Wonderful to welcome our colleagues in Nepal and Indonesia to the RECOVERY trial of COVID treatments.
First patients enrolled in Nepal - thank you Teku Hospital, Patan Hospital,
@BasnyatBuddha
, Nepal Health Research Council.
Another RECOVERY trial milestone. 2000 COVID patients enrolled in comparison of convalescent plasma versus usual NHS care. 1000 vs 1000.
Massive thanks to all the plasma donors, NHS staff, NHSBT and patients.
We need to keep on recruiting -
#answerbyXmas
4. The rapid growth rate in infections was quickly and correctly predicted, precisely based on real world data from South Africa.
Fast growth rates offset reduced severity.
Omicron cases are doubling every 2 days. A halving of severity would be completely discounted in 2 days
Good result on use of wolbachia to reduce dengue transmission. Congratulations Katie Anders and team. 'Miraculous' mosquito hack cuts dengue by 77% - BBC News
If they were a scientist they would not look at one graph in isolation and reach a conclusion, they would look at the totality of evidence - and say “yes”.
RECOVERY has shown that it is possible to massively accelerate medical advances and massively decrease costs. Estimated cost of £250 per patient enrolled - a fraction of other clinical trials.
The speed of therapeutic innovation cominhg from RECOVERY trial is sensational!
This should be the model for every common disease from heart disease to Alzheimer’s, osteoporosis to IBD
Nothing would accelerate innovation for patients faster. Who’s going to be first?
Please, no regrets. Donating plasma has made a major contribution to advancing COVID care. It might have worked but the trial was needed to know for sure. A negative result is hugely important. We learn about COVID and refocus our efforts.
#Covid19
: I’m really sad to read this 😢
I have no regrets though for taking part in the research trials. Onwards and upwards to mitigating, minimising and managing this bastard virus. Convalescent plasma no benefit to hospital patients - BBC News
2. Other respiratory viruses are not increasing in UK.
See line with the black triangles in figure.
"The overall influenza positivity is low ...Respiratory syncytial virus (RSV) positivity decreased ... Rhinovirus positivity remained stable at 11.4% in week 49."
Updated information on SARS-CoV-2 variant B.1.1.7
Results from the cohort study found no statistically significant difference in hospitalisation and 28-day case fatality between cases with the variant (VOC 201212/01) and wild-type comparator cases.
Just after 2pm today, RECOVERY passed a landmark of 10,000 patients recruited in January alone.
An extraordinary contribution by patients and by people working under enormous pressure in hospitals across the UK.
Thank you for advancing COVID care.
#NHS
#NIHR
#UKRIfunding
Although negative, this result is incredibly important and moves forward the treatment of COVID. This was only possible thanks to the generosity of recovered patients and the willingness of current patients to contribute to advancing medical care. We owe you all a great debt.
3. Changes in the virus can explain the multiplicative increase.
"Omicron SARS-CoV-2 infects and multiplies 70 times faster than the Delta variant and original SARS-CoV-2 in human bronchus"
As well as preventing infections and severe disease, COVID vaccination also reduces household transmisson.
Get vaccinated to protect yourself and others.
In the Netherlands, a quarter of all journeys are made by bicycles. In terms of environmental benefit, this is equivalent to planting 54 million trees a year. 🇳🇱🚲🌳
Most of the assessments of CP failed to take into account the almost 80 year history of the vital importance of randomisation and the inherent unreliability of observational data.
13,000 participants now in the RECOVERY trial of COVID-19 treatments. Incredible achievement - thank you everyone.
Need to keep pushing to get answers on the great portfolio of treatments being tested now - azithromycin, convalescent plasma, monoclonal antibody and tocilizumab.
Allowing widespread use of unproven treatments creates confusion and undermines chances of improving care through proper science. US allows emergency use of blood plasma treatment for coronavirus patients
Amazing. Brilliant work by Vietnam (no deaths) and by Bệnh viện Bệnh nhiệt đới. Vietnamese determination at its very best.
BBC News - Patient 91: How Vietnam saved a British pilot and kept a clean Covid-19 sheet
⏩40,000 COVID patients now recruited to RECOVERY trial.
Phenomenal effort by front-line staff
@NHSuk
,
@NIHRresearch
,
@NHSDigital
,
@Oxford_NDPH
,
@NDMOxford
Remarkable contribution by patients and their families.
Together improving COVID care & saving lives.
Thank you.
No benefit from high-titre convalescent plasma in critically adults with COVID.
REMAP-CAP COVID-19 Convalescent Plasma Randomized Clinical Trial via
@JAMA_current
part of
@JAMANetwork
RECOVERY manuscript now fully published: Casirivimab and imdevimab in patients admitted to hospital with COVID-19
Randomised trial of 9785 patients.
Casirivimab and imdevimab reduces mortality in seronegative patients.
Molnupiravir is now being evaluated in RECOVERY.
Whilst we have proof-of-concept, through monoclonals, that antivirals can be beneficial in severe COVID, we are struggling to find effective antivirals.
Combination antiviral therapy the way forward?
Avian flu makes me nervous ++ We need to be ready for it becoming more transmissible between humans.
Between 2020–2023, 26 countries reported >48 mammal species infected by H5N1. Geographic area and No. of species affected has increased.
/eid/article/30/3/23-1098_article
@JeremyFarrar
@OECD
Today NI has 9 ICU beds available, of which 6 are in paediatric ICU, 1 in cardiac ICU.
Essentially there are now 2 ICU beds remaining in NI for COVID cases.
RECOVERY 25k: I know we keep saying it - but can't say it enough - an astonishing achievement by the NHS, NIHR, DHSC, patients and their families. Making an unparalleled contribution to global health at a time of crisis.
RECOVERY Trial Update:
- 25,000 patients enrolled, incl:
- 2800 to tocilizumab vs. usual care
- 11,100 to convalescent plasma vs. REGN-COV2 vs. usual care
- 5,200 to aspirin vs. usual care
These are such difficult times. Getting answers is so important. Huge thanks to everyone.
Most of us have seen this video by now. But worth watching again. The advice is just as relevant as we hit new peaks in many countries as it was at the beginning.
New placebo controlled trial results do not support the use of ivermectin in outpatients with mild to moderate COVID-19. Effect of Ivermectin vs Placebo on Time to Sustained Recovery in Outpatients With Mild to Moderate COVID-19
The burden on those making grant applications must be reduced. It is a major barrier, especially to less well resourced researchers.
In a recent application I was involved in, the actual science started on page 100 of 168 pages.
This is really great news. Important to remember how many people early on believed that steroids would be harmful, based on studies of other diseases, and were reluctant to consider randomisation.
POTUS, like many thousands of other COVID patients, is benefiting from those patients who went before and selflessly volunteered to be in a clinical trial. Everyone can give back by supporting clinical trials in anyway they can. Let's find better treatments for everyone.
So Trump is now also receiving dexamethasone.
@WHO
guidelines very clear that it is to be used only “in patients with severe and critical
#COVID19
”. Guidelines incl. “conditional recommendation not to use corticosteroid therapy in patients with non-severe
#COVID19
”.
>14,000 patients in RECOVERY. Remarkable effort by thousands of people - a triumph of the NHS working under extreme pressure. Together we will find new treatments.
The pandemic has further highlighted the importance of large RCTs in guiding best clinical practice. Hats off to everyone across the UK involved in the RECOVERY trial. The rapid response has been truly remarkable 👏👏
Cases of severe pneumonia of unknown aetiology reported from Argentina.
Cases in healthcare workers are a concerning signal - could indicate person-to-person transmission or a point source (such a legionella).
A privilege to accept the award on behalf of the enormous and exceptional RECOVERY collaborative group.
Massive thanks to the trial team
@UniofOxford
led by Professor Richard Haynes and the many thousands of dedicated people at
@NHSuk
@NIHRresearch
@DHSCgovuk
Congratulations to The RECOVERY Collaborative Group for their paper Dexamethasone in Hospitalized Patients with Covid-19, and winning UK Research Paper of the Year
@PeterHorby
@MartinLandray
#TheBMJAwards
Encouraging result. Molnupiravir reduced risk of hospitalisation or death by about 50%. 7.3% of patients who got molnupiravir were hospitalized or died through Day 29 following randomization (28/385), compared to 14.1% placebo-treated patients (53/377); p=0.0012
RECOVERY Trial to investigate sotrovimab as a possible treatment for hospitalised COVID-19 patients.
Sotrovimab, a monoclonal antibody that targets a conserved region of the coronavirus spike protein, retains activity against the Omicron variant.
⏩ New RECOVERY trial result.
Monoclonal antibody combination reduces deaths in seronegative patients hospitalised with COVID-19.
- 9785 patients randomised
- primary analysis population 3153 patients without own SARS-CoV2 antibodies detectable at randomisation (seronegative)
Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis
RECOVERY Colchicine result out now as pre-print
11340 patients hospitalised with COVID-19 randomised to colchicine vs usual care
Unfortunately no evidence of clinical benefit in primary or secondary outcomes, or in any patient subgroups.
Monoclonal antibodies now being tested in RECOVERY trial. We are rolling this experimental therapy out to hospitals as quickly as we can, so we can find out if it works as quickly as we can.
18% convalescent plasma vs. 18% usual care alone; risk ratio 1.04 [95% confidence interval 0.95-1.14]; p=0.34. Follow-up of patients is ongoing and final results will be published as soon as possible.