Delving into the data from the Lancet P2 peer review.28 Dec 2020 00:22
When the Lancet P2 peer review came out, I didn’t have time to delve deeper into the details, but one thought that did linger at the time and since was how equal the two groups were: SNG001 and the placebo. In particular, I wondered if the type and related seriousness of the comorbidities had had a big influence on the results, especially as the SNG001 group had more people with high blood pressure.
Here are the details. I’ve also worked out the average number of comorbidities per person with comorbidities in each group. It’s pretty even amongst the two groups:
Placebo 50 people, 27 with comorbidities, 41 total comorbidities, average 1.52 per person
SNG001 48 people, 26 with comorbidities, 37 total comorbidities, average 1.42 per person
Of those in each group with comorbidities, here are the percentages:
High blood pressure: SNG001: 69%, Placebo: 41%
Chronic lung condition: SNG001: 42%, Placebo: 44%
Cardiovascular disease: SNG001: 19%, Placebo: 30%
Diabetes: SNG001: 12%, Placebo: 33%
Cancer: SNG001: 0 patients, Placebo: 1
I wondered if High blood pressure was less serious for Covid-19 patients than other conditions, especially cardiovascular disease and Diabetes, and therefore having an influence on the results of the trial. So, I did some digging and found a few reports on the chances of dying of Covid-19 based on different comorbidities. Here are two relevant reports:
The first shows that case fatality rates for comorbid patients are materially higher than the average population: Cancer: 5.6%, Hypertension:6.0%, Chronic respiratory disease: 6.3%, Diabetes:7.3%, Cardiovascular disease: 10.5%
Source: American College of Cardiology (ACC)
There’s a pdf here: bulletin released by the American College of Cardiology (ACC) on March 6, 2020.
The second study uses RR (Relatively risk). For example: a RR score of 1.50 means a 50% higher likelihood of mortality. The RR figures for 4 of the key comorbidities were: Cardiovascular disease: 2.25, Hypertension (High blood pressure): 1.82, Diabetes: 1.48, Cancer: 1.47.
The study is here:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238215
In conclusion. The SNG001 P2 study has a higher weighting of people with high blood pressure and lower weighting of people with cardiovascular disease and diabetes. High blood pressure IS a key comorbidity for Covid-19 and has a similar or higher contribution to death with Covid-19 than diabetes, but less than with Cardiovascular disease. In reality the key comorbidity to be worried about if there was a big discrepancy between the two groups is Cardiovascular disease. The placebo group did have more people with this condition, but only 8 vs 5. So overall, I feel much more confident now about the potential of SNG 001, given that the severity of comorbidities between the SNG 001 and placebo groups in the P2 trial are closer than I had thought might be the case.