February 27, 2021

Background: As the COVID pandemic rages on, we continue to search for treatments to help combat the disease. Severely ill patients commonly have low levels of vitamin D and it has been suggested that optimal levels of Hydroxyvitamin D may have some immunomodulatory and anti-inflammatory properties which could benefit patients.  Vitamin D supplementation is cheap and has relatively minimal side effects making it an intriguing treatment modality. However, the data is limited.

February 20, 2021

Background: COVID-19 typically starts as a mild illness that progresses over several days. Most treatment interventions for COVID-19 are focused on hospitalized patients who have progressed past this mild illness.  Monoclonal antibodies have been heavily touted in this role for patients at high-risk of decompensation but have fallen well short of expectations and are prohibitively expensive and resource intensive. [BLAZE-1] [REGN-COV2]Easily accessible effective treatments are badly needed for patients with mild COVID-19 not requiring hospitalization. Many reports have shown an under representation of patients with asthma and chronic obstruct pulmonary disease in patients hospitalized with COVID-19. One hypothesis is this may be due to the use of inhaled glucocorticoids in these patients.  Inhaled glucocorticoids have been shown to reduce exacerbations of both asthma and COPD.

February 19, 2021

Update: This article was removed from the Lancet server on February 19th, 2021 (Link)

Background: Vitamin D deficiency is common amongst critically ill patients and there has been ample speculation about a possible role for supplementation (with calcifediol) in the treatment of patients with COVID19. Calcifediol is cheap, readily available and, has minimal side effects making it an ideal therapeutic - if it works. To date, there is limited high-quality evidence on efficacy.

February 12, 2021

Background: Publication of the RECOVERY trial results on Dexamethasone were game changing - the drug had a clear reduction in mortality in patients requiring oxygen. Since then, we have had little to celebrate in terms of therapeutics in those with moderate to severe disease. The beneficial effects of corticosteroids in COVID-19 patients with hypoxic lung damage suggests other, more specific immunomodulatory agents may provide additional patient-oriented improvements.

Enter Tocilizumab.  This is a recombinant anti-IL6 receptor monoclonal antibody that inhibits binding of IL-6 to receptors that signal inflammation.  The results of tocilizumab from randomized trials thus far have shown mixed results for benefit.  Many of the trials not showing benefit were smaller, however the larger REMAP-CAP trial [2] did report benefit in patients requiring organ support. Further data is clearly needed to guide clinicians.

January 23, 2021

Background: One of the many massive challenges of the COVID19 pandemic has been the lack of targeted therapeutics. Extensive efforts have been invested into research with only glimmers of benefit for most drugs. The exception to this has been dexamethasone which was shown in the RECOVERY trial to have remarkable impacts on death in patients requiring O2 (NNT = 29) and in those requiring invasive ventilation (NNT = 8.5). A number of other drugs showed promise in observation and retrospective studies (HCQ, convalescent plasma) only to prove ineffective in well-done RCTs. Others (i.e. remdesivir) have shown inconsistent results at best. 

Monoclonal antibody infusions have gained national attention as a potential therapeutic. This drug class works by binding to domains on SARS-CoV2 spike protein blocking its ability to bind to ACE2 receptors on cells and thus stopping cellular invasion. Previously, we reviewed the interim analysis of BLAZE-1 which demonstrated a small reduction in viral load with one of the three studied doses. However, this difference fell below the author’s preset threshold, raised questions of biological plausibility and found no difference in any clinically meaningful outcome. Additionally, we recently reviewed the REGN-CoV2 antibody cocktail data which also failed to demonstrate any meaningful benefits. Today, we dive into the full BLAZE-1 data as the study has been completed.

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