[新聞] WHO: Remdesivir 對存活率沒影響

[med5566 (美德5566)]

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1.原文連結：
https://reurl.cc/OqmNpv
2.原文內容：

Anti-viral drug remdesivir has little to no effect on Covid patients' chances of survival, a study from the World Health Organization (WHO) has found.

The WHO trial evaluated four potential medications for Covid-19, including remdesivir and hydroxychloroquine.

Remdesivir was among the first to be used to treat coronavirus, and was recently given to US President Donald Trump when he was in hospital.

The drug's manufacturer Gilead rejected the findings of the trial.

In a statement, Gilead said the findings of the study were "inconsistent" with others, and that it was "concerned" that the results have yet to be reviewed.

What did the WHO study find?
For its Solidarity clinical trial, the WHO tested the effects four potential treatments - remdesivir, an Ebola drug, was one, but they also looked at malaria drug hydroxychloroquine, auto-immune drug interferon, and the HIV drug combination of lopinavir and ritonavir.

Dexamethasone, a low-cost steroid now widely used on Covid patients in intensive care in the UK, was not included in this study.

The four drugs were tested with 11,266 adult patients in total, across 500 hospitals in more than 30 different countries.

Dexamethasone, remdesivir and Regeneron explained
What drugs can help treat coronavirus?
US buys nearly all of Covid-19 drug remdesivir
The results, which are yet to be peer-reviewed, suggest that none of these treatments has a substantial effect on mortality or on the length of time spent in hospital, the WHO said on Thursday.

WHO chief scientist Soumya Swaminathan said on Wednesday that their trials on hydroxychloroquine and lopinavir/ritonavir were stopped in June because they had already proven ineffective. However, the other trials continued.

The WHO's results appear to contradict a previous study from earlier this month, conducted by Gilead, which concluded that treatment with remdesivir cut Covid recovery time by five days compared to patients given a placebo. About 1,000 patients took part in that trial.

What has the reaction been?
Gilead Sciences Inc dismissed the findings.

"The emerging (WHO) data appears inconsistent, with more robust evidence from multiple randomised, controlled studies published in peer-reviewed journals validating the clinical benefit of remdesivir," the company said in a statement.

"We are concerned the data from this open-label global trial has not undergone the rigorous review required to allow for constructive scientific discussion, particularly given the limitations of the trial design."

But Prof Martin Landray, who runs the large trial Recovery in the UK, said the results of the trial were "important but sobering" - and added that there were already concerns about the cost and accessibility of remdesivir.

"Covid affects millions of people and their families around the world," he added.

"It is not a rare disease. We need scalable, affordable and equitable treatments. The WHO Solidarity trial has done the world a huge favour by producing clear, independent and robust results, showing once more the value of large randomised trials in providing the knowledge we need to tackle the worst consequences of the pandemic."

Remdesivir was given emergency use authorisation in the US from the country's Food and Drug Administration (FDA) on 1 May. Later that month it was approved for use in the UK, and has since been authorised for use in several other countries.

Remdesivir has been touted as a potential therapy since the beginning of the pandemic and gained greater attention when it formed part of Donald Trump's cocktail of treatments.

But the WHO trial, published online, gives a damning verdict.

There is a bit of uncertainty in the data, but the study says it "absolutely excludes" the idea remdesivir can save a significant number of lives and says the findings are "comfortably compatible" with the drug having no life-saving effect at all. It is a similar message for preventing people needing ventilation or speeding up people's recovery.

So far, doctors have been raiding the cupboard for existing drugs that can fight coronavirus.

The results have been disappointing with malaria drugs, HIV drugs, MS drugs and now an Ebola drug (remdesivir). Only an old steroid - dexamethasone - has proven life-saving.

The attention is now turning to new experimental therapies such as antibodies designed in the lab to fight the virus and new, untested, anti-viral drugs.

We are still waiting for the results of these trials, but the worry is "new" in medicine tends to mean "expensive", and that will raise questions about who gets to have them.

What about other Covid treatments?
Following the results of the Solidarity trial, Dr Swaminathan said the WHO was now "looking at what's next".

"We're looking at monoclonal antibodies, we're looking at immunomodulators and some of the newer anti-viral drugs that have been developed in the last few months," she said.

Meanwhile in China researchers say a vaccine under development has been found to be safe and to trigger immune responses in combined early and mid-stage trials.

However the researchers said it was not possible to say whether the antibody responses induced by the vaccine were sufficient to protect from infection because the trial was not designed to assess its efficacy.

Developed by the Beijing Institute of Biological Products, the vaccine has already been approved for an emergency inoculation programme in the country.


簡單翻譯一下大致的內容

WHO做了一個 "Solidarity clinical trial"

(https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1.full.pdf)

比較瑞德西偉、氯奎寧、干擾素、抗HIV的Lopi/Ritonaivr

在三十個國家進行11266個成人的研究

在這些藥物「沒有一個對於死亡或是住院天數」可以改善。

其中氯奎寧跟抗ＨＩＶ甚至在六月就因已證實無效而停止研究了

吉利德公司則是發出聲明：

WHO的paper在檢視資訊這塊比起之前證明瑞德西韋有臨床效益的RCT更不嚴謹

特別是WHO的臨床試驗設計方式有著更多的設限。

Prof Martin Landra（牛津大學流行病學教授)則認為

瑞德西韋本身的花費跟可取得性對於一個Pandemic(大流行)疾病是存疑的

而WHO這篇實驗是重要且令人深思的

並且認為該研究結果是清楚、獨立且證據充足的

對於COVID-19我們需要的是一個，合理且負擔得起的治療方式。

3.心得/評論：

出自BBC的新聞，WHO認為瑞德西韋暨不是解藥

連甚至下降住院日數、呼吸器的需求都做不到

目前唯一有效的只有dexa這款類固醇，特別是需要呼吸器治療的這塊


一切預告在前瑞德西韋就是解藥 vs 吉利德股價Z已經到了

這次會還給誰公道？

--
        Ihrem Ende eilen sie zu,

        die so stark in Bestehen sich wähnen.

        Fast schäm' ich mich, mit ihnen zu schaffen.

--
※ 發信站: 批踢踢實業坊(ptt.cc), 來自: 42.77.249.228 (臺灣)
※ 文章網址: https://www.ptt.cc/bbs/Stock/M.1602897930.A.493.html
→ abyssa1     : 類固醇？不愧是美國仙丹 又是它
→ Leo4891     : 折折預告在前  誰敢嘴?
推 bitlife     : 墊腳石計畫已經結束,我們繼續看黑薔薇計畫
→ chanollili  : cho任何話都當鬼話
NEJM在10/8也有篇文章提到瑞德西韋
（https://www.nejm.org/doi/full/10.1056/NEJMoa2007764）

和安慰劑相比，使用瑞德西韋可以減少住院天數和嚴重的下呼吸道感染


→ jones2011   : WHO講的話全部反向解讀就對了
推 zetatmrptt  : 一切的一切都預告在前
※ 編輯: med5566 (42.77.249.228 臺灣), 10/17/2020 09:45:58
推 koster      : 身為WHO做實驗如此粗糙 一點都不專業 到底在幹嘛?
→ jones2011   : 疫情越大諸國越沒空理中→cho會做不利中的事？
→ koster      : WHO這實驗不雙盲 也沒有依照疾病程度分組 就下結論
推 samwu995    : GILD股價都趴在地上了
→ milkBK      : https://i.imgur.com/W4WRJGp.jpg
推 takataka    : 一個謊言
→ milkBK      : 醫藥專家哲哲說明明就很有用
推 jimmyid4    : 等到中國研發出來就有效了，偉哉CHO
→ jimmyid4    : cherry picking
噓 henryyeh5566: 過陣子who推薦板藍根雙黃連都不意外呵呵
推 GoogleDocs  : 瑞德西韋如果真的有效
→ GoogleDocs  : 早就噴了
→ GoogleDocs  : 還等你WHO
→ GoogleDocs  : 股價說明一切
→ GoogleDocs  : 目前看所有療法就川普最有效
→ GoogleDocs  : 川普就是神
→ abyssa1     : 川普的治療神奇到大家懷疑他根本詐病
→ simplewish  : 川普治療時也有吃瑞德 效益那麼差最好會吃
噓 leon80148   : 政治意圖明顯
推 fat980      : 就看 生華科 跟國鼎誰會先上
推 keswickdada : 現在折折還敢講瑞德西尾嗎
推 kusomanfcu  : 早就說啦 維他命 還有效一點都不信
→ kusomanfcu  : 一直警告 sec在提醒相關詐欺
→ kusomanfcu  : https://www.ptt.cc/bbs/Stock/M.1587705148.A.2E5.
→ kusomanfcu  : html
→ kusomanfcu  : https://reurl.cc/Z7NLnV
→ koster      : 輕症會自己好這種說法不一定正確 還是要看本藥是否
→ koster      : 降低輕症轉重症的機率 像流感很多人不吃藥也自己好
→ koster      : 但是只要降低輕症變重症機率 就會跟克流感一樣狂發
→ koster      : 不過武肺目前的給藥方式不適合給輕症 所以要等其他
→ koster      : 的給藥方式出來 才有辦法推廣使用 像川普這種一發現
→ koster      : 就馬上可以進醫院打針的例子太少了
推 sliverstream: 寧願信藥商廣告,可悲吱XDDD
推 kissa0924307: CHO之前不是講不要戴口罩？？
推 kamichu     : 等抗體藥
推 qaz27966    : CHO從年初至今的所有發言後面看都真的是反指標
推 banbanzon   : https://www.ctwant.com/article/43710 3月底還要大
→ banbanzon   : 家不要戴口罩咧
推 pujos       : 不知道哪個傻逼會信瑞德西韋有用，是被倒貨倒不夠嗎
推 ganbee      : WHO是不是跟網紅一樣怕被人忘記，偶爾要出來刷存在
→ ganbee      : 感.
噓 cssula      : 這隻塞怎麼還在當小丑
→ robinnibor  : 國鼎就一個沒路用公司
→ IBIZA       : 台灣政府三月也說沒病不用戴口罩啊...
→ IBIZA       : https://www.youtube.com/watch?v=orY94asdCAs
→ IBIZA       : 還好沒人相信
噓 achiyeng    : 垃圾WHO