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All Studies   Meta Analysis    Recent:   

Early Treatment with Pegylated Interferon Lambda for Covid-19

Reis et al., New England Journal of Medicine, doi:10.1056/NEJMoa2209760, TOGETHER, NCT04727424
Feb 2023  
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Mortality 27% Improvement Relative Risk Mortality, day 28 61% Hospitalization 42% Hospitalization or ER >6hr.. 51% primary Peg.. Lambda  TOGETHER  EARLY TREATMENT  DB RCT Is early treatment with peginterferon lambda beneficial for COVID-19? Double-blind RCT 1,949 patients in Brazil (June 2021 - February 2022) Lower hospitalization (p=0.039) and fewer hosp./ER visits (p=0.0027) Multiple critical issues, see discussion c19early.org Reis et al., New England J. Medicine, Feb 2023 Favorspeg.. lambda Favorscontrol 0 0.5 1 1.5 2+
The TOGETHER trial has extreme COI, impossible data, blinding failure, randomization failure, uncorrected errors, and many protocol violations. Authors do not respond to these issues and they have refused to release the data as promised. Some issues may apply only to specific arms.
High-risk outpatient RCT with 931 peginterferon lambda patients and 1,018 control patients, showing significantly lower hospitalization/ER visits with treatment. Single subcutaneous injection.
There were 85/931 and 286/1018 patients for which baseline SARS-CoV-2 status was unknown, p = 1.4e-27 (about 1 in 704 septillion).
The most frequent risk factors were more common in the placebo group, for example obesity 39.1% control vs. 34.5% treatment, p = 0.04.
Authors claim patients were unaware or the randomization assignments, however some patients received oral placebo in a trial of a treatment requiring subcutaneous injection.
The numbers in Table 1 and Table S1 do not match, e.g., the text and Table 1 indicate 931 ITT interferon patients, while Table S1 shows 916.
All deaths in the placebo arm were attributed to COVID-19, while only 50% were in the interferon arm. One placebo death is listed as both due to COVID-19 and due to acute myeloid leukemia (Table S6).
See also1.
The TOGETHER trial has extreme COI, impossible data, blinding failure, randomization failure, uncorrected errors, and many protocol violations. Authors do not respond to these issues and they have refused to release the data as promised. Some issues may apply only to specific arms. For more details see2-6.
risk of death, 27.1% lower, RR 0.73, p = 0.76, treatment 4 of 931 (0.4%), control 6 of 1,018 (0.6%), NNT 626, all-cause, Table S6.
risk of death, 61.0% lower, RR 0.39, p = 0.32, treatment 1 of 931 (0.1%), control 4 of 1,018 (0.4%), adjusted per study, attributed to COVID, day 28.
risk of hospitalization, 42.0% lower, RR 0.58, p = 0.04, treatment 21 of 931 (2.3%), control 40 of 1,018 (3.9%), NNT 60, adjusted per study, day 28.
hospitalization or ER >6hrs, 51.0% lower, RR 0.49, p = 0.003, treatment 25 of 931 (2.7%), control 57 of 1,018 (5.6%), NNT 34, adjusted per study, day 28, primary outcome.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Reis et al., 9 Feb 2023, Double Blind Randomized Controlled Trial, placebo-controlled, Brazil, peer-reviewed, 41 authors, study period 24 June, 2021 - 7 February, 2022, trial NCT04727424 (history) (TOGETHER).
This PaperPeg.. LambdaAll
Early Treatment with Pegylated Interferon Lambda for Covid-19
Gilmar Reis, Eduardo A S Moreira Silva, Daniela C Medeiros Silva, Lehana Thabane, Vitoria H S Campos, Thiago S Ferreira, Castilho V Q Santos, Ana M R Nogueira, Ana P F G Almeida, Leonardo C M Savassi, Adhemar D Figueiredo-Neto, Ana C F Dias, Adelino M Freire Júnior, Carina Bitarães, Aline C Milagres, Eduardo D Callegari, Maria I C Simplicio, Luciene B Ribeiro, Rosemary Oliveira, Ofir Harari, Lindsay A Wilson, Jamie I Forrest, Hinda Ruton, Sheila Sprague, Paula Mckay, Christina M Guo, Eve H Limbrick-Oldfield, Steve Kanters, Gordon H Guyatt, Craig R Rayner, Christopher Kandel, Mia J Biondi, Robert Kozak, Bettina Hansen, M Atif Zahoor, Paul Arora, Colin Hislop, Ingrid Choong, Jordan J Feld, Edward J Mills, Jeffrey S Glenn
New England Journal of Medicine, doi:10.1056/nejmoa2209760
BACKGROUND The efficacy of a single dose of pegylated interferon lambda in preventing clinical events among outpatients with acute symptomatic coronavirus disease 2019 (Covid-19) is unclear. METHODS We conducted a randomized, controlled, adaptive platform trial involving predominantly vaccinated adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brazil and Canada. Outpatients who presented with an acute clinical condition consistent with Covid-19 within 7 days after the onset of symptoms received either pegylated interferon lambda (single subcutaneous injection, 180 μg) or placebo (single injection or oral). The primary composite outcome was hospitalization (or transfer to a tertiary hospital) or an emergency department visit (observation for >6 hours) due to Covid-19 within 28 days after randomization. RESULTS A total of 933 patients were assigned to receive pegylated interferon lambda (2 were subsequently excluded owing to protocol deviations) and 1018 were assigned to receive placebo. Overall, 83% of the patients had been vaccinated, and during the trial, multiple SARS-CoV-2 variants had emerged. A total of 25 of 931 patients (2.7%) in the interferon group had a primary-outcome event, as compared with 57 of 1018 (5.6%) in the placebo group, a difference of 51% (relative risk, 0.49; 95% Bayesian credible interval, 0.30 to 0.76; posterior probability of superiority to placebo, >99.9%). Results were generally consistent in analyses of secondary outcomes, including time to hospitalization for Covid-19 (hazard ratio, 0.57; 95% Bayesian credible interval, 0.33 to 0.95) and Covid-19-related hospitalization or death (hazard ratio, 0.59; 95% Bayesian credible interval, 0.35 to 0.97). The effects were consistent across dominant variants and independent of vaccination status. Among patients with a high viral load at baseline, those who received pegylated interferon lambda had lower viral loads by day 7 than those who received placebo. The incidence of adverse events was similar in the two groups. CONCLUSIONS Among predominantly vaccinated outpatients with Covid-19, the incidence of hospitalization or an emergency department visit (observation for >6 hours) was significantly lower among those who received a single dose of pegylated interferon lambda than among those who received placebo. (Funded by FastGrants and others; TOGETHER ClinicalTrials.gov number, NCT04727424.
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the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Luciene B.', 'family': 'Ribeiro', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Rosemary', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'ORCID': 'http://orcid.org/0000-0002-2901-0558', 'authenticated-orcid': False, 'given': 'Ofir', 'family': 'Harari', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Lindsay A.', 'family': 'Wilson', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Jamie I.', 'family': 'Forrest', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Hinda', 'family': 'Ruton', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Sheila', 'family': 'Sprague', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Paula', 'family': 'McKay', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Christina M.', 'family': 'Guo', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Eve H.', 'family': 'Limbrick-Oldfield', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Steve', 'family': 'Kanters', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Gordon H.', 'family': 'Guyatt', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Craig R.', 'family': 'Rayner', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Christopher', 'family': 'Kandel', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Mia J.', 'family': 'Biondi', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Robert', 'family': 'Kozak', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Bettina', 'family': 'Hansen', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'M. Atif', 'family': 'Zahoor', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Paul', 'family': 'Arora', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Colin', 'family': 'Hislop', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Ingrid', 'family': 'Choong', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Jordan J.', 'family': 'Feld', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; the Research Division, ' 'Cardresearch–Cardiologia Assistencial e de Pesquisa (G.R., ' 'E.A.S.M.S., D.C.M.S., V.H.S.C.,...'}]}, { 'given': 'Edward J.', 'family': 'Mills', 'sequence': 'additional', 'affiliation': [ { 'name': 'From ViRx@Stanford, Stanford Biosecurity and Pandemic ' 'Preparedness Initiative (G.R., J.S.G., E.J.M.), and the ' 'Departments of Medicine (Division of Gastroenterology and ' 'Hepatology) and Microbiology and Immunology, Stanford University ' 'School of Medicine (J.S.G.), Stanford, and the Veterans Affairs ' 'Medical Center (J.S.G.) and Eiger BioPharmaceuticals (C.H., ' 'I.C.), Palo Alto — all in California; 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