inDemic Perspectives

Expert commentary on COVID-19 challenges and solutions

Perspectives on WHO’s SOLIDARITY Trial: Disappointing Findings Limit Remdesivir’s Use in COVID-19 Patients

| Sam Sun |

Last week, the World Health Organization (WHO) published data from its SOLIDARITY trial on a preprint server. The SOLIDARITY trial is a global, pragmatic, adaptive, master protocol trial investigating 4 therapies for hospitalized COVID-19 patients, including remdesivir. Disappointing findings for remdesivir in the SOLIDARITY trial elicited a statement from Gilead Sciences, questioning the validity of SOLIDARITY, and emphasizing its ACTT-1 trial as the “gold standard” regarding remdesivir’s value for COVID-19.

Projections for “The COVID-19 Vaccines Timeline”

| Sam Sun |

Vaccines against COVID-19 could be available as early as the end of this year, and Russia has already granted full regulatory approval to its vaccine candidate. inDemic.org tracks the clinical development, regulatory milestones, and manufacturing capacity associated with each of the most promising vaccines to show not only when vaccines could be approved but also when they could be rolled out for at-risk populations (e.g. healthcare workers) and the general public. Comments or questions regarding the Vaccines Timeline can be sent anytime to director@indemic.org.

Catalysts for “The COVID-19 Therapeutics Watchlist”

| Sam Sun |

Of the hundreds of agents being tested, inDemic.org selects the drugs most likely to have a significant impact on patients with COVID-19. The Watchlist is dynamic, with new drugs added and current drugs dropping off whenever new data prompts the changes. Selection for the Watchlist is based primarily on clinical trial data, but also on compelling mechanisms of action, signals of efficacy in compassionate use programs, and practical considerations such as manufacturing and distribution capacity to meet worldwide demand. Nominations for the Watchlist or other comments can be sent anytime to director@indemic.org.

Expert Perspectives: Thromboembolic Disease in COVID-19

As part of an ongoing series of “Expert Perspectives”, Dr. Leon Henderson-MacLennan, Medical Advisor to inDemic Foundation and inThought Research, discusses the role of thromboembolic disease in COVID-19, and its implications for developmental therapeutics. Dr. Leon Henderson-MacLennan describes the rationale for conducting randomized, placebo-controlled trials on anticoagulants and anticomplement agents for COVID-19 associated thromboembolic disease, and highlights several agents and mechanisms of action to watch closely.

Expert Perspectives: Q&A on Actemra’s phase 3 EMPACTA study

| Bob Dickson |

In the first of an ongoing series of “Expert Perspectives” with members of inDemic Foundation’s scientific advisory board, we discuss data from EMPACTA, a randomized, double-blind, placebo-controlled phase 3 trial evaluating the efficacy and safety of Roche’s Actemra (tocilizumab) in hospitalized patients with COVID-19 pneumonia (NCT04372186). Actemra is one of several IL-6 inhibitors that’s been evaluated for patients with COVID-19.  At the time of this writing, data from EMPACTA has not been published in a peer-reviewed journal, but some of its key findings have been released by Roche/Genentech.  

A Tale of Two Timelines

| Sam Sun |

In the midst of growing public and scientific concern regarding the integrity of clinical trials for COVID-19 vaccines, Moderna publicly released its 135-page clinical study protocol. Of biopharma companies with a COVID-19 vaccine candidate in phase 3 trials, Moderna is the first to publicly release its study protocol. The overall goal or primary endpoint of the Moderna’s phase 3 trial is to show that mRNA-1273 has a vaccine efficacy (VE) of 60% in preventing COVID-19. In biostatistics parlance, the VE is [1-HR], or 1 minus the hazard ratio. That is, the goal is to show that healthy participants who receive Moderna’s vaccine are 40% as likely to develop COVID-19, compared to participants that receive placebo. In the trial, a case of COVID-19 is defined as:

  • At least TWO of the systemic symptoms: fever (at least 100.4 degrees), chills, muscle aches, headache, sore throat, loss of taste or smell;
  • At least ONE of the respiratory symptoms: cough, shortness of breath, difficulty breathing, or pneumonia; AND, 
  • At least ONE nasopharyngeal, nasal, saliva, or respiratory test that’s positive for SARS-CoV-2

Clinical Trials Accrual in a Pandemic

| Sam Sun |

“It was the best of times; It was the worst of times”

COVID-19 has forced a re-think of clinical trial design, enrollment, and execution. Among the challenges of clinical trial investigators are the ethical principles of compassionate (“off-label”) use of investigational therapies vs. randomized, placebo-controlled trials [1-2], as well as the logistical challenges of manufacture and distribution of investigational therapies [2].

Here, we discuss a peculiar and paradoxical challenge of clinical trials accrual in a pandemic. For any clinical trial – whether it be for cancer, Alzheimer’s disease, or diabetes – identifying and enrolling patients is a well-known challenge. For example, targeted therapies for cancers may enroll patients with rare mutations, who may be difficult to identify and to enroll onto a clinical trial at a limited number of cancer centers [3]. It is peculiar that, as millions of patients are infected by SARS-CoV-2, that there are insufficient patients for clinical trials, whose accrual goals are typically a few hundreds of patients.

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