The Weekly Dose
September 24, 2020
Welcome to The Weekly Dose! Each week, we will review one scientific article, summarizing the research and providing key takeaways. Our goal in this endeavor is to make science understandable and accessible to all.
As flu season quickly approaches, the need for reliable and effective treatment of COVID-19 is essential. This week, we reviewed an article that presents the results of a phase 3 trial of remdesivir, a broad-spectrum antiviral medication, among patients hospitalized with moderate COVID-19. Previous research has shown remdesivir to be effective for patients with severe COVID-19, reducing recovery time and improving clinical status. Two questions, however, remain unanswered by the previous studies: one, whether the drug is effective for less-severe cases, and two, what is the optimal duration of treatment.

In this particular trial, researchers evaluated the efficacy and safety of remdesivir among 584 patients with moderate COVID-19 who were drawn from 105 hospitals across the United States, Europe, and Asia. Patients were randomly assigned a 5-day course of remdesivir, a 10-day course of remdesivir, or standard care.* On day 11 of treatment, each patient’s clinical status was evaluated on a scale from 1 (Death) to 7 (Not Hospitalized). The study’s authors then compared the distributions of the clinical-status scale across the three groups.
This study revealed that patients who were administered 5 days of remdesivir had better clinical status on day 11 than patients who received standard care. The 5-day group was 65% more likely to not be hospitalized (relative to all other clinical statuses) and no more likely to experience adverse events than the standard-care group. The clinical status of patients receiving 10 days of remdesivir treatment was not significantly better than that of patients who received standard care; moreover, the 10-day remdesivir group was more likely to experience such adverse events as headache, nausea, and hypokalemia (low blood-potassium).
*Patients randomized to the remdesivir groups received 200 mg intravenously, infused over 30 to 60 minutes, on day 1, followed by 100 mg of remdesivir once daily on subsequent days. 

Key Takeaways:

  • Remdesivir’s efficacy in this trial shows promise for treating moderate COVID-19. The results suggest that 5 days of remdesivir treatment improves clinical status without additional risk of adverse outcomes. 
  • Continued research is necessary to draw more robust conclusions about the efficacy and safety of remdesivir. To that end, the investigators have added a non-randomized extension phase to the trial, in which 1,000 additional patients could be enrolled to receive remdesivir. 
  • The study does have an important limitation, which is that the efficacy conclusions are, roughly speaking, based on a comparison across the three study groups of the distribution of patients in the 7 clinical statuses. (See Table 2.) However, that distribution is not in any way uniform, and several statuses have 0 patients within them. The authors have built in some statistical adjustments and key assumptions to address this limitation, and the results derived from the extension phase can be used to validate the findings of this study. 

Who is VSC?

Vital Statistics Consulting (VSC) is a healthcare consultancy that specializes in the evaluation of policies and programs and provides independent, rigorous, innovative analysis to support data-driven recommendations that improve healthcare quality and organizational efficiency.
What's New at VSC?
Just a reminder that VSC’s podcast, Unbiased Science, is live on Stitcher, Spotify, Apple, and most other major podcast platforms. Now available for listening is Episode 1, on which our podcasters, Drs. Steier and Love, addressed the question, “How will the COVID-19 vaccine work if preliminary evidence shows that the antibodies people develop after getting sick only last a few months?” Be sure to listen and follow us on social media (@unbiasedscipod).

Also, register here for a free educational conference offered by AllianceChicago and the Health Choice Network, a network of 52 safety net organizations across the country. This conference will feature lessons learned on virtual care delivery within community health center settings, marshalling data for decision-making, and CHC research on COVID-19. We’ll be tuning in and recommend that you check it out, too!
Employee Spotlight

Each week, The Weekly Dose will introduce readers to one of our team members.

This week, VSC Medical Informatics Consultant, Sukhpreet Pabla, MHA, MBT, is in the “spotlight.” We have asked him three questions, the answers to which reveal some of his professional and personal inspiration for working in the field of health science.   

Which people and/or events influenced your decision to work in this field?

I have always had a love for numbers. I’m the guy who’s more interested in the stats while watching the ball game than the actual home run, touchdown or goal. Growing up in a traditional East-Indian household, I was encouraged by my family to pursue a career in the sciences, and so I started out working in the biotech space, helping to develop a genetic test for predicting breast cancer risk. With the biotech and pharma industry struggling during the recession in 2009, I decided to expand into the patient-care space. Heeding the advice of my long-time friend and now colleague, Ramon Llamas, I decided to attend the University of Southern California to obtain a Masters in Healthcare Administration. Upon graduating, I discovered that Hospital and Provider operations were being transformed by transitioning from paper records to electronic health records. The Big Data era was embarking in Healthcare and I fully wanted to embrace the opportunity to help organizations make impactful decisions using analytics. I’ve since been able to implement EPIC and multiple analytical tools at many healthcare organizations on the West Coast.

What was the answer you gave people as a child when asked what you want to be when you grow up? 

My answer was either a doctor or scientist.

What advice would you give yourself 3 years ago? 3 years from now? 

I would give the same advice to both my past and future self. Be patient and flexible. A career is a journey with many turns and forks in the road. Expecting it to be a straight and expedited path can sometimes set you up for disappointment. Follow the path that provides you with the opportunity to work with what you love, whether that is numbers, people or theory.
We welcome your feedback! Tell us what you think of The Weekly Dose and feel free to send article suggestions for future editions. Contact us by e-mail at info@vscgrp.com or call us at 1-877-VIT-STAT.