Eli Lilly says its monoclonal antibody cocktail is effective against Covid-19

https://www.statnews.com/2020/10/07/eli-lilly-monoclonal-antibody-cocktail-covid-19/

by jseliger • 6 years ago

78 73 6 years ago

war10256• 6 years ago

Sounds like Trump got a similar cocktail from a different company. The speed of his recovery and the fact that him having Coronavirus isn't even part of the news cycle anymore seems like a strong indicator that the treatment is probably a game changer.

satya71• 6 years ago

Only problem, I suspect, is it's super expensive and hard to produce in the large amounts required. So not as much of a game changer as we'd like. Still should save a few lives.

war10256• 6 years ago

Trump released a statement a few hours ago that they have hundreds of thousands of doses available and he's going to push to make it free to patients.

Obviously, it's still unclear how the politics of all of it play out, but seems more promising than most things we've seen so far.

ethbr02• 6 years ago

it's super expensive and hard to produce in the large amounts required

It's hard, but less hard than some things. And we've been working on them for the last ~35 years.

Here's a primer if you're curious: https://blogs.sciencemag.org/pipeline/archives/2020/04/27/mo...

MyelinatedT• 6 years ago

Trump might still go south... It's hard to tell what's true on that front, and it's still early days.

Still looks promising though.

musicale2• 6 years ago

I assume that from Trump's perspective going south would not be a promising outcome.

gameswithgo3• 6 years ago

A single person's progression with covid tells us absolutely nothing about the efficacy of the drugs he took.

war10256• 6 years ago

Well, it might not, but the article is about Eli Lilly saying their studies say the drug is effective, and the anecdotal evidence that Trump took it and recovered very quickly seems to add credence to that claim.

People love to hate on anecdotes, but they have their place.

musicale2• 6 years ago

A single data point, even a somewhat uncertain one, is still a data point.

BurningFrog• 6 years ago

If he dies right when taking the drug, I think it says something.

hashtagmarkup• 6 years ago

A single person's progression who was in every single category of death susceptible patients tells us more than the recovery of an otherwise healthy person's progression.

coding123• 6 years ago

I don't understand how one person treated with something, just because they recovered, makes this a game changer. I also don't get why it would take "curing" the president to know of a specific cocktail that works.

I kinda am losing all faith in all things medicine if we've had experience, as a whole, to try to treat 36 MILLION people with this issue and one specific treatment for one specific person, who happens to survive like 35 MILLION others so far. And THATS the winning combo, And it happens to be our president. It's like the other 35 MILLION was just junk data or something.

war10256• 6 years ago

The relevance is that the President got wall to wall media coverage for being sick. And his is in a demographic (old, overweight, male) that puts him at an extremely elevated risk for serious illness.

Doctors will do their job and scientists will do their job, and in the end decisions will be made based on the results of studies.

That doesn't negate the enormous amount of positive press that this event will give to the treatment.

Either way, it should be a signal that we are getting much better at treating the illness. Back in April, Boris Johnson, who is basically a Trump equivalent, but 20 years younger, spent a week in the hospital in very rough shape.

The news on Cornavirus is in trending significantly in the positive direction, which is really all that matters.

phobosanomaly9• 6 years ago

There are 151 vaccine candidates in preclinical and 42 in clinical trials globally.

https://www.who.int/publications/m/item/draft-landscape-of-c...

There are thousands and thousands of people in the biomedical field all around the world working furiously behind the scenes at the moment on this problem.

Unfortunately, there is no single mouthpiece for this effort so people aren't aware of how many people are pulling out the stops, but despite how bleak things may look there are a lot of MDs and PhDs and MD/PhDs trucking away trying to find a way out of this thing.

tathougies• 6 years ago

Trump's illness is still the most likely outcome for anyone with covid. The biggest difference is that the man is tested everyday.

analog31• 6 years ago

Perhaps one useful outcome of that experiment is that testing alone doesn't prevent a workplace from becoming a super spreader site.

segmondy• 6 years ago

Yup, which lead to early treatment. Most people start treatment when the illness has progressed far. Hospitals generally withhold treatment to see if patients will recover by themselves because they can't risk "waste" of medicine and filling up hospital beds. So most people are sent home unless it's really bad. Trump started getting treatment from the very moment he tested positive.

avs733• 6 years ago

relying on a PR team for data (who has a perfectly reasonable national security reason for lying about that data) and then using a single point of data to make claims is just so antiscience I can't even.

pengaru• 6 years ago

It could just as well be a strong indicator that his initial viral exposure was small, and/or that being detected early, treated quickly and exceptionally well by a dedicated team matters.

tankist• 6 years ago

Detail info about his treatment been discussed by TViW https://pca.st/episode/015f8d9c-7c9b-443a-a7eb-3bdf06e9602d

bronco21016• 6 years ago

Why are we assuming he’s out of the woods and “cured”? All of the medical experts seem to indicate that 7-10 days is when the real complications begin. The earliest we know him to be infected is Wednesday of last week. He’s just coming up on the 7 day threshold.

Let’s at least wait through the weekend before we declare him “cured”.

dTal• 6 years ago

Exactly. I'm shocked at how many people are taking Trump's "recovery" at face value.

rsynnott2• 6 years ago

I... think that would be an _extremely_ premature assumption.

HarryHirsch• 6 years ago

Meanwhile, convalescent plasma does nothing at all for Ebola patients, and efficacy against coronaplague is at best low.

delhanty7• 6 years ago

It's completely predictable that the expensive drugs that Trump got (the monoclonal antibodies & Remdesivir) dominate the news cycle, while the cheap ones don't. From, the Physician to the President's report on October 2nd [0]:

Following PCR-confirmation of the President’s diagnosis, as a precautionary measure he received a single 8 gram dose of Regeneron’s polyclonal antibody cocktail. He completed the infusion without incident. In addition to the polyclonal antibodies, the President has been taking zinc, vitamin D, famotidine, melatonin and a daily aspirin.

If there's a game changing drug for COVID-19 in there I'd say it was vitamin D.

We covered the Spanish randomized open label, double-masked clinical trial of vitamin D just over a month ago. [1][2]

“Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%) p value X2 Fischer test p < 0.001.”

[0] https://twitter.com/PressSec/status/1312122950133272576

[1] https://www.sciencedirect.com/science/article/pii/S096007602...

[2] https://news.ycombinator.com/item?id=24366006

deelowe• 6 years ago

That trial has several issues. Everyone is patiently awaiting larger RCTs to further understand if Vitamin D does anything as a prophylactic. It's been shown to not be helpful in severe cases.

cameldrv• 6 years ago

The Spanish RCT was for hospitalized patients. What study shows that it's not helpful for severe cases?

delhanty7• 6 years ago

That trial has several issues.

Which are what?

It's been shown to not be helpful in severe cases.

That's a fairly strong assertion! Stronger than, "there is no evidence that is helpful in severe cases" for example.

You wouldn't happen to have a reference to back it up by any chance?

Anyway, I'm wondering why vitamin D is held to a higher standard than the polyclonal antibodies or Remdesivir. Where is the evidence that they're helpful in severe cases?

By the way, I'm not advocating for long-term, high-dose consumption (say over 2000 IU) consumption of vitamin D.

Deva Boone (devaboone) 's blog points out that this can lead to dangerously high calcium levels and has been covered on here several times recently [0][1]:

Eventually we worked out what happened with Shannon: In 2013 she was diagnosed with mild osteopenia, a thinning of the bones that can be a precursor to osteoporosis. Her Vitamin D was low at the time, so her physician started her on over-the-counter Vitamin D supplementation at 5000 international units (IUs) daily. Five years later, she was still on this dose, and her blood Vitamin D level had risen to 79 ng/ml. This level is within what many labs call the normal range, between 30 and 100 ng/ml, but levels above 70 are almost always a result of high dose supplementation, and I have seen toxicity with levels between 70 and 100 ng/ml. (A better “normal range” based on what I have seen would probably be between 30 and 60.) Vitamin D builds up over time, so the longer someone is on a high dose, the more likely she is to develop toxicity. Shannon’s calcium levels began rising in the fall of 2018, when her severe symptoms developed.

What we should be doing now is mass-testing the at-risk population to identify those people with blood levels below 30 ng/ml and then do what is necessary to bring them up into the 30 to 40 ng/ml range. Ideally that could be done with sunlight, or food high in vitamin D - for example oily fish, liver, dried-shitake, ... But for the at risk demographic, in practice one would probably need moderately high-dose supplements, combined with monthly testing until they're above 30 ng/ml, followed by a switch to a lower-dose maintenance dose.

[0] https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-st...

[1] https://news.ycombinator.com/item?id=24261948

phobosanomaly9• 6 years ago

The Internet Book of Critical Care is a collaborative effort by front-line docs to share information about promising therapies and approaches to COVID.

It's really interesting, and broken down by bullet points.

Check it out, and get an idea of how actual doctors in the field are approaching this thing.

https://emcrit.org/ibcc/covid19/

Joah Farkas, an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont who runs IBCC isn't bullish on Vit D.

https://covidprotocols.org/protocols/therapeutics/

Neither is Brigham and Women's Hospital, which is Harvard Medical School's teaching and research hospital.

https://hms.harvard.edu/affiliates/brigham-womens-hospital

Neither is U Penn academic medical department.

http://www.uphs.upenn.edu/antibiotics/COVID19.html

Neither is the American Thoracic Society.

https://www.thoracic.org/covid/covid-19-guidance.pdf

Neither is anyone at my academic teaching hospital.

A lot of really smart people with decades of experience in the field, and a direct clinical role have collected a variety of approaches that seem to work. Unfortunately, none of them have characterized Vit D as a 'game changing drug.'

I think it might be wise to hold off on phrases like 'game changing' with regards to Vitamin D.

Not to say that it may not eventually play a role as part of a multifaceted approach.

delhanty7• 6 years ago

Re: "game changer", I was referencing the comment by war1025 that polyclonal anti-bodies were a game changer.

Sounds like Trump got a similar cocktail from a different company. The speed of his recovery and the fact that him having Coronavirus isn't even part of the news cycle anymore seems like a strong indicator that the treatment is probably a game changer.
A lot of really smart people with decades of experience in the field, and a direct clinical role have collected a variety of approaches that seem to work. Unfortunately, none of them have characterized Vit D as a 'game changing drug.'

Sorry - I'm more impressed by a single randomized open label, double-masked clinical trial than I am by argument by authority. Perhaps we can check back here in a couple of years time ...

I can't help remembering how actual doctors in the field were telling us back in February to "get a flu shot", or "masks only work for doctors who've been trained to put them on properly". I'm so happy that I'd already purchased my N95 masks in January while you guys were asleep.

all_blue_chucks• 6 years ago

This is promising technology, but the words "just barely statistically significant" should probably be in the first paragraph of articles covering this - not halfway down the article.

mlyle2• 6 years ago

"Just barely statistically significant" but the MLE is a 6x reduction in hospital visits. There's huge potential here, but our ability to know has been hampered by study size.

jszymborski• 6 years ago

yes, I think this is a prime example of the "early results are promising but more testing is needed" platitude

sxg• 6 years ago

That's not quite the right takeaway. That 6x reduction is dependent on the p-value, which in turn is dependent on the sample size. The larger the sample, the smaller the p-value, and that 6x reduction will likely shrink as well. It's extremely rare for a treatment in medicine to have a 6x benefit.

Animats• 6 years ago

They didn't tell us how many patients. Could be important, could be noise. Also, there were two serious reactions to infusion of one of the drugs.

It's progress. A few months ago nothing worked. It was just ventilators, supportive treatment, and wait to see who survived. Now, some treatments sort of work. Management of the disease is becoming possible.

In this study, the drugs were given early, and to patients who were not sick enough to require hospitalization. Not clear if this helps with the more serious cases.

jholman2• 6 years ago

What are the numbers "112" and "156" doing in the article?

jholman2• 6 years ago

That's for one of several results, and the whole point of those words appearing is to imply that it contrasts with the other results.

I mean, arguably reporting on things at this stage is super premature, the whole article shouldn't exist, we shouldn't be reading it, the whole news cycle is garbage, blah blah blah rant rant rant.... but it would be absurd to headline the article with "the least significant, of several significant results, was only barely significant".

collyw• 6 years ago

Aren't monocolonial antibodies usually pretty expensive?

Eli Lilly says its monoclonal antibody cocktail is effective against Covid-19

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