What we know about Trump's Covid-19 treatment plan

Since testing positive for Covid-19, President Trump has been treated with Gilead's remdesivir, Regeneron's experimental antibody cocktail, and the steroid dexamethasone. Trump’s treatment plan makes the president something of an N-of-1 , since it’s unclear whether Regeneron’s unapproved drug has been robustly tested in volunteers in his age and health demographic — or in combination with the other medications he’s receiving.

It also raises questions about whether Trump's illness is more serious than his physicians have suggested — particularly since he was treated with dexamethasone, which is usually reserved for severe cases of the virus. “At least what they’re doing, it makes it seem like he’s pretty sick,” said Krutika Kuppalli, an infectious disease physician, tells STAT's Andrew Joseph. “There’s a disconnect there.”

There will be many lessons we learn from Trump’s personal battle with Covid-19, STAT’s Matthew Herper writes — but the biggest takeaway seems to be that there are no magic bullets against the novel coronavirus.

Boosting the efficacy of checkpoint inhibitors (in mice)

Immunotherapy is a potent tool against cancer, but it’s got plenty of limitations. For instance, many patients initially respond well to PD-1 checkpoint inhibitors but build up resistance — particularly if the cancer has metastasized to the liver. A new UCSF study, published in Science Immunology, may help explain why — in mice, anyway.

Cancer cells can skulk in various outposts in the body, hiding from the immune system. The liver helps regulate the immune system, so it’s a particularly effective place to dodge attacks. The UCSF scientists mimicked metastases in mice and found that the liver tumors were “uniquely suppressive” and more able to retrain the immune system to ignore their proliferation.

The researchers found adding a second type of checkpoint inhibitor in a combination therapy, though, could prevent resistance. Specifically, an anti-CTLA-4 checkpoint inhibitor drug helped improve the efficacy of an anti-PD-1 therapy — a finding the researchers hope will one day be translated to the clinic.

Manufacturing medicines in the U.S.

Covid-19 has laid bare how snags in international drug supply chains can impact medication distribution stateside. Consequently, there’s been an uptick in efforts to encourage American-made medicines, with both President Trump and the Biden campaign outlining plans to preferentially buy medications made in the U.S.

It’s controversial, though — some argue a “buy American” push could distract from efforts to develop new medicines. Others think it’s not tenable to quickly bring such a complex supply chain back to the U.S.

Martin Vantrieste, who leads Utah-based nonprofit generic drug company Civica Rx, makes the case for American-made drugs.

Ransomware attack stymies some Covid-19 trials

Hackers mounted a ransomware attack on a software company called eResearchTechnology that’s being used to help manage a number of Covid-19 clinical trials, the New York Times reports. The attack, which impacted several of ERT’s high-profile customers, slowed some of the trials over the past two weeks by holding data hostage and demanding payment to release it.

IQVIA, a CRO working on AstraZeneca’s Covid-19 vaccine trial, was affected by the attack, along with Bristol Myers Squibb, which is helping develop a rapid test for the virus. It’s unclear how many trials in total were impacted by the attack, or who is responsible for the breach.

“We are not aware of any confidential data or patient information, related to our clinical trial activities, that have been removed, compromised or stolen,” IQVIA said in a statement to the Times.