Do We Finally Have a Treatment for COVID-19 That Saves Lives?
If you’re reading this, then you are probably one of the millions closely following the search for a COVID-19 cure. You’ve likely become familiar with the various drugs that have been investigated — some with more popularity or success than others.
In fact, sometimes it seems as though the most popular medications have proven to be the least effective. Scientific evidence has been pretty clear that, despite celebrity endorsements, hydroxychloroquine has not been shown to reduce mortality in patients with COVID-19.
Dr. Anthony Fauci spoke to the US Senate earlier this month about treatment with another drug, remdesivir. That moment, incidentally, feels like the last time anyone heard from Dr. Fauci. He said about the drug, “We must remember it was only a modest result showing that the drug made a 31% faster time to recovery.” Fauci was referring to a trial since published in the New England Journal of Medicine that showed remdesivir to decrease recovery time from 15 to 11 days. Unfortunately it did not quite demonstrate a statistically significant reduction in mortality. I’ve prescribed remdesivir in the hospital setting, and based on my observation, I would agree with Dr. Fauci’s use of the word ‘modest’ to describe its effect on the coronavirus.
Fauci went on to talk about convalescent plasma and, of course, a vaccine which remains in the distant or not-quite-so-distant future depending on who you ask. The studies on convalescent plasma are encouraging but small. Investigations with larger numbers are underway to see if convalescent plasma can demonstrate a survival benefit, and hopefully it will.
There is another treatment that hasn’t received as much coverage possibly because it isn’t one individual drug. It’s a broad category of blood thinners called anticoagulants. A recent pre-proof study of over 2500 patients from the Journal of the American College of Cardiology showed that anticoagulation can decrease the mortality of critically ill patients with the coronavirus from a frightening 63% to a somewhat less daunting 29%.
Medical providers, including myself, often use prophylactic doses of blood thinners such as heparin or enoxaparin to prevent blood clots in hospitalized patients particularly in those with additional risk factors for blood clots, but now these medications are being administered to hospitalized patients who have no risk factors for clots other than having COVID-19.
When using a medication to prevent an adverse outcome, an important number to consider is the number needed to treat (NNT). The NNT means the number of patients who need to receive a treatment in order to prevent one bad outcome such as stroke, heart attack, or death. Drugs with the lowest NNT carry the greatest benefit. For example, in patients with stroke, the NNT for aspirin to prevent severe disability or death from a second stroke is 79. For patients taking medications to correct high blood pressure over a span of five years, the NNT to prevent one death is 125. When used as prophylaxis, the NNT for oseltamivir (Tamiflu) to prevent one case of symptomatic influenza is 33.
There isn’t an NNT for oseltamivir to prevent one death from the flu because it hasn’t actually been shown to decrease mortality in patients with influenza. Likewise, hydroxychloroquine and remdesivir don’t have an NNT to prevent a death from COVID-19 because they haven’t exhibited the ability to do so.
Based on the study above, the NNT for anticoagulation to prevent one death from COVID-19 is, drumroll please…3! Before we become overly excited, remember, we’re talking about a single health-system study that hasn’t been published in its final form, and this NNT is only in regard to the sickest patients in the hospital (i.e. those on mechanical ventilation). So, more research is definitely needed, but if this data even remotely reflects the true benefit of anticoagulation, then it is among the best news to date on the battle against the coronavirus.