[jyl]

NIAD trial of remedsivir in moderate and severe pts met endpoint (succeeded in showing benefit). Fauci gave a little more: improved time to clinical improvement, reduced mortality. This was a real placebo controlled trial. Details to come.

This, plus the little bit of info from GILD’s own trial and the aborted Chinese trials, and what we know about supply and mode of administration, strongly suggest:

- the drug has a real, proven benefit
- the benefit is moderate rather than huge, though could be larger if dosed earlier
- drug will be in very short supply for rest of 2020 at least
- for at least 2020, only genuine GILD-made drug is likely to be trustworthy, we’ve already seen that Chinese copy drug is unreliable
- while it likely has most benefit if dosed early, good chance it gets reserved for pts who progress to more advanced disease - unless you are a VIP
- from a macro POV, it probably reduces need for ventilation and reduces mortality, rather than really reducing need for hospital beds

I would expect this drug to be approved in the next 30 days.

Next to watch, for the existing drugs being tested, is Actemra. Even though Kevaza failed, and they are both IL-6 inhibitors, the early Actemra data still gives some hope. This will be a drug for severe cases, if it works.

We’ve not yet seen a drug that works for milder cases, or a drug that works and is in ample supply.

Attention probably turns now to vaccine progress. I’m unimpressed by success in monkey models. Human trials are underway/about to start for several candidates. I still think pretty good chance of one or more fairly effective vaccines by early/mid 2021, in enough supply that frontline HCW and the most vulnerable ppl in rich countries can get it. If you’re in India or Brazil, sorry.