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David Boulware

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David Boulware
Born1974 (age 49–50)
United States
CitizenshipUnited States, United Kingdom[explain status]
Alma materIndiana University School of Medicine
OccupationPhysician infectious diseases (medical specialty)
Years active2004–present
Known forCOVID-19, meningitis, HIV researcher
TitleProfessor of Medicine at University of Minnesota

David Boulware is a professor of medicine and a practicing infectious disease physician at the University of Minnesota Medical School. He is a member of the graduate faculty for the University of Minnesota School of Public Health Epidemiology PhD program and for the Microbiology, Immunology, and Cancer Biology (MICaB) graduate program. Boulware was the first Lois & Richard King Distinguished Assistant Professorship at the University of Minnesota. Boulware is an active medical researcher engaged in clinical trials in infectious diseases.[1] His expertise is particularly in the realm of HIV-related meningitis, including Cryptococcosis and Tuberculous meningitis.

Education

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Boulware graduated from Wabash College in 1996 with a Bachelor of Arts in Chemistry.[2] He later attended the Indiana University School of Medicine, graduating in 2000.[3] He completed various residencies and fellowships from 2000-2007, receiving a certificate in tropical medicine from the Centers for Disease Control and Prevention (CDC) in 2006. He completed his master's in public health in 2007.

Career

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Boulware joined the faculty of the University of Minnesota in 2007, becoming an Assistant Professor of Medicine in the Division of Infectious Disease and International Medicine at the University of Minnesota’s Department of Medicine. Around the same time, he began working within the university’s Center for Infectious Diseases and Microbiology Translational Research (CIDMTR) to study HIV/AIDS and cryptococcal meningitis with the Infectious Diseases Institute in Uganda.[4]

He was named to the Lois and Richard King Distinguished Assistant Professorship at the school in 2011.[2]

COVID-19

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Boulware's primary research has been focused on improving the diagnosis, prevention, and treatment of cryptococcal meningitis.[5] However, he is best known for outpatient COVID-19 clinical trials, pioneering remote de-centralized, internet-based clinical trials during the COVID-19 pandemic.

Boulware's team rapidly launched a series of three U.S. nationwide randomized clinical trials testing hydroxychloroquine for post-exposure prophylaxis, early treatment, and pre-exposure prophylaxis for prevention of COVID-19 on March 17, 2020.[6] These were among the first U.S. trials to be launched.[7] The pre-exposure prophylaxis trial was reported June 3, 2020 showing that taking hydroxychloroquine was not effective at preventing COVID-19.[8][9][10] As described, "To say that the recruitment of this post-exposure prophylaxis trial was innovative hardly gives the methods enough credit."[11] These trials were pioneering for being remote internet-based randomized decentralized clinical trials.[12][13]

The hydroxychloroquine early treatment trial was the first large phase III, outpatient randomized clinical trial testing an outpatient therapy for COVID-19.[14][15] Subsequent, meta-analysis of 11 outpatient hydroxychloroquine randomized trials of 2037 participants showed zero benefit for reducing hospitalization[16] While pre-exposure prophylaxis with hydroxychloroquine for prevention was promoted on May 18, 2020,[17] the subsequent randomized trial did not show any benefit.[18]

Describing the experimental antiviral drug remdesivir in June 2020, Boulware said that the medicine could provide "a reasonable value" if it reduced the length of stay in hospital for COVID-19 patients.[19] This true early in the pandemic waves when hospital beds were in limited supply.

Boulware served as senior investigator on other trials testing early treatments for COVID-19 including the TogetherTrial ivermectin;,[20][21] which demonstrated that ivermectin did not have a clinical benefit for early COVID-19.[22] University of Minnesota's COVID-Out randomized trial testing metformin, ivermectin, and fluvoxamine.[23] The Covid-Out trial reported a 42% reduction in COVID-related emergency room visits and hospitalizations through 14-days with the use of metformin.[24] Metformin also had a 58% reduction in hospitalizations through 28-days and reduced long COVID by 41% through 10-months. In December 2021 at the beginning of the Omicron wave, Boulware took the initiative to apply to the U.S. FDA for an Emergency Use Authorization for fluvoxamine 100 mg twice daily.[25] This low cost generic medicine of fluvoxamine reduced covid-related hospitalizations by 25% as well as reducing ER visits and hospitalizations.[26] FDA rejected the EUA request for this low cost generic medicine questioning whether reducing prolonged ER visits and hospitalizations represents a clinically meaningful benefit.[27] Dr. Boulware has been a proponent of repurposed medicines which actually have benefit for COVID-19, including metformin, interferon-lambda, and higher-dose fluvoxamine.[28]

Boulware serves as the national co-chair of the trial steering committee for the NIH ACTIV-6 platform clinical trial testing repurposed medicines for COVID-19.[29][30] ACTIV-6 trial has tested outpatient COVID-19 therapies including ivermectin, inhaled fluticasone, low-dose fluvoxamine 50mg twice daily, fluvoxamine 100mg twice daily, montelukast, and metformin.

Notable contributions and honors

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References

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  1. ^ "David R Boulware". University of Minnesota. Archived from the original on 2023-05-18. Retrieved 2023-05-21.
  2. ^ a b "Dr. David Boulware '96/King Distinguished Professor at UMN – Alumni News". Wabash College. 2011-11-04. Archived from the original on 2023-05-17. Retrieved 2023-05-17.
  3. ^ Boulware, David R. (2021-04-29). "Clinical & Translational Research in Cryptococcosis" (PDF). Mycoses Study Group Education & Research Consortium. Archived (PDF) from the original on 2023-05-17. Retrieved 2023-05-17.
  4. ^ Schmickle, Sharon (2008-11-13). "University of Minnesota doctors battle AIDS in Uganda". MinnPost. Archived from the original on 2010-06-23. Retrieved 2023-05-21.
  5. ^ Adams, Patrick (4 January 2016). "Crushing Crypto, the deadly, neglected disease that kills 300K every year". Newsweek.
  6. ^ Boulware, David R.; Pullen, Matthew F.; Bangdiwala, Ananta S.; Pastick, Katelyn A.; Lofgren, Sarah M.; Okafor, Elizabeth C.; Skipper, Caleb P.; Nascene, Alanna A.; Nicol, Melanie R.; Abassi, Mahsa; Engen, Nicole W.; Cheng, Matthew P.; LaBar, Derek; Lother, Sylvain A.; MacKenzie, Lauren J.; Drobot, Glen; Marten, Nicole; Zarychanski, Ryan; Kelly, Lauren E.; Schwartz, Ilan S.; McDonald, Emily G.; Rajasingham, Radha; Lee, Todd C.; Hullsiek, Kathy H. (6 August 2020). "A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for COVID-19". New England Journal of Medicine. 383 (6): 517–525. doi:10.1056/NEJMoa2016638. PMC 7289276. PMID 32492293.
  7. ^ Palca, Joe (31 March 2020). "Clinical Trials Set To Determine If Anti-Malaria Drug Effective Against COVID-19". NPR.
  8. ^ Grady, Denise (3 June 2020). "Malaria Drug Promoted by Trump Did Not Prevent COVID Infections, Study Finds". The New York Times.
  9. ^ "Hydroxychloroquine, a drug promoted by Trump, failed to prevent healthy people from getting covid-19 in trial". Washington Post.
  10. ^ "White House asked for Dr. Boulware's advice on hydroxychloroquine. This is what he said - CNN Video". CNN.
  11. ^ Sax, Paul (7 June 2020). "Hydroxychloroquine Not Effective in Preventing COVID-19 -- In Praise of a Negative Clinical Trial". HIV and ID Observations. NEJM Journal Watch.
  12. ^ Adam, Rogers. "The Strange and Twisted Tale of Hydroxychloroquine". Wired.
  13. ^ "How to Conduct a Clinical Trial During a Pandemic—An Interview with Dr. David Boulware". Open Forum Infectious Diseases. 7 (7): ofaa277. 1 July 2020. doi:10.1093/ofid/ofaa277. PMC 7534549. PMID 33043070.
  14. ^ "Hydroxychloroquine studies show drug is not effective for early treatment of mild covid-19". Washington Post.
  15. ^ Skipper, Caleb P.; Pastick, Katelyn A.; Engen, Nicole W.; Bangdiwala, Ananta S.; Abassi, Mahsa; Lofgren, Sarah M.; Williams, Darlisha A.; Okafor, Elizabeth C.; Pullen, Matthew F.; Nicol, Melanie R.; Nascene, Alanna A.; Hullsiek, Kathy H.; Cheng, Matthew P.; Luke, Darlette; Lother, Sylvain A.; MacKenzie, Lauren J.; Drobot, Glen; Kelly, Lauren E.; Schwartz, Ilan S.; Zarychanski, Ryan; McDonald, Emily G.; Lee, Todd C.; Rajasingham, Radha; Boulware, David R. (20 October 2020). "Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19: A Randomized Trial". Annals of Internal Medicine. 173 (8): 623–631. doi:10.7326/M20-4207. PMC 7384270. PMID 32673060.
  16. ^ Mitjà, Oriol; Reis, Gilmar; Boulware, David R.; Spivak, Adam M.; Sarwar, Ammar; Johnston, Christine; Webb, Brandon; Hill, Michael D.; Smith, Davey; Kremsner, Peter; Curran, Marla; Carter, David; Alexander, Jim; Corbacho, Marc; Lee, Todd C.; Hullsiek, Katherine Huppler; McDonald, Emily G.; Hess, Rachel; Hughes, Michael; Baeten, Jared M.; Schwartz, Ilan; Metz, Luanne; Richer, Lawrence; Chew, Kara W.; Daar, Eric; Wohl, David; Dunne, Michael (March 2023). "Hydroxychloroquine for treatment of non-hospitalized adults with COVID -19: A meta-analysis of individual participant data of randomized trials". Clinical and Translational Science. 16 (3): 524–535. doi:10.1111/cts.13468. PMC 10014689. PMID 36601684.
  17. ^ McDonald, Jessica; Rieder, Rem (21 May 2020). "Trump Misleads on Hydroxychloroquine, Again". FactCheck.org.
  18. ^ Rajasingham, Radha; Bangdiwala, Ananta S; Nicol, Melanie R; Skipper, Caleb P; Pastick, Katelyn A; Axelrod, Margaret L; Pullen, Matthew F; Nascene, Alanna A; Williams, Darlisha A; Engen, Nicole W; Okafor, Elizabeth C; Rini, Brian I; Mayer, Ingrid A; McDonald, Emily G; Lee, Todd C; Li, Peter; MacKenzie, Lauren J; Balko, Justin M; Dunlop, Stephen J; Hullsiek, Katherine H; Boulware, David R; Lofgren, Sarah M; Abassi, Mahsa; Balster, Andrew; Collins, Lindsey B; Drobot, Glen; Krakower, Douglas S; Lother, Sylvain A; MacKay, Dylan S; Meyer-Mueller, Cameron; Selinsky, Stephen; Solvason, Dayna; Zarychanski, Ryan; Zash, Rebecca (1 June 2021). "Hydroxychloroquine as Pre-exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) in Healthcare Workers: A Randomized Trial". Clinical Infectious Diseases. 72 (11): e835–e843. doi:10.1093/cid/ciaa1571. PMC 7665393. PMID 33068425.
  19. ^ "Drug company to charge thousands for coronavirus treatment". NBC News. Associated Press. 2020-06-29. Archived from the original on 2022-11-08. Retrieved 2023-05-18.
  20. ^ "TOGETHER Trial". TOGETHER Trial.
  21. ^ Reis, Gilmar; Silva, Eduardo A.S.M.; Silva, Daniela C.M.; Thabane, Lehana; Milagres, Aline C.; Ferreira, Thiago S.; dos Santos, Castilho V.Q.; Campos, Vitoria H.S.; Nogueira, Ana M.R.; de Almeida, Ana P.F.G.; Callegari, Eduardo D.; Neto, Adhemar D.F.; Savassi, Leonardo C.M.; Simplicio, Maria I.C.; Ribeiro, Luciene B.; Oliveira, Rosemary; Harari, Ofir; Forrest, Jamie I.; Ruton, Hinda; Sprague, Sheila; McKay, Paula; Guo, Christina M.; Rowland-Yeo, Karen; Guyatt, Gordon H.; Boulware, David R.; Rayner, Craig R.; Mills, Edward J. (5 May 2022). "Effect of Early Treatment with Ivermectin among Patients with COVID-19". New England Journal of Medicine. 386 (18): 1721–1731. doi:10.1056/NEJMoa2115869. PMC 9006771. PMID 35353979.
  22. ^ Zimmer, Carl (30 March 2022). "Ivermectin Does Not Reduce Risk of COVID Hospitalization, Large Study Finds". The New York Times.
  23. ^ "COVID-OUT: Early Outpatient Treatment for SARS-CoV-2 Infection (COVID-19)". ClinicalTrials.gov. 2 March 2022.
  24. ^ Bramante, Carolyn T.; Huling, Jared D.; Tignanelli, Christopher J.; Buse, John B.; Liebovitz, David M.; Nicklas, Jacinda M.; Cohen, Kenneth; Puskarich, Michael A.; Belani, Hrishikesh K.; Proper, Jennifer L.; Siegel, Lianne K.; Klatt, Nichole R.; Odde, David J.; Luke, Darlette G.; Anderson, Blake; Karger, Amy B.; Ingraham, Nicholas E.; Hartman, Katrina M.; Rao, Via; Hagen, Aubrey A.; Patel, Barkha; Fenno, Sarah L.; Avula, Nandini; Reddy, Neha V.; Erickson, Spencer M.; Lindberg, Sarah; Fricton, Regina; Lee, Samuel; Zaman, Adnin; Saveraid, Hanna G.; Tordsen, Walker J.; Pullen, Matthew F.; Biros, Michelle; Sherwood, Nancy E.; Thompson, Jennifer L.; Boulware, David R.; Murray, Thomas A. (18 August 2022). "Randomized Trial of Metformin, Ivermectin, and Fluvoxamine for Covid-19". New England Journal of Medicine. 387 (7): 599–610. doi:10.1056/NEJMoa2201662. PMC 9945922. PMID 36070710. S2CID 251659997.
  25. ^ "Doctor Submits Fluvoxamine EUA Application to FDA". www.medpagetoday.com. 29 December 2021.
  26. ^ Lee, Todd C.; Vigod, Simone; Bortolussi-Courval, Émilie; Hanula, Ryan; Boulware, David R.; Lenze, Eric J.; Reiersen, Angela M.; McDonald, Emily G. (6 April 2022). "Fluvoxamine for Outpatient Management of COVID-19 to Prevent Hospitalization: A Systematic Review and Meta-analysis". JAMA Network Open. 5 (4): e226269. doi:10.1001/jamanetworkopen.2022.6269. PMC 8987902. PMID 35385087.
  27. ^ "Memorandum Explaining Basis for Declining Request for Emergency Use Authorization of Fluvoxamine Maleate" (PDF). FDA. Retrieved 5 March 2022.
  28. ^ "Three effective treatments for COVID-19 not (yet) in guidelines". IDSA Podcast. Retrieved 23 March 2023.
  29. ^ "Activ-6 Study".
  30. ^ "ACTIV-6: COVID-19 Outpatient Randomized Trial to Evaluate Efficacy of Repurposed Medications". clinicaltrials.gov. 22 March 2022.
  31. ^ "Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy". www.who.int. World Health Organization.
  32. ^ "Guidelines for the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children". www.who.int. World Health Organization.
  33. ^ "US HHS/NIH/CDC HIV Opportunistic Infection Guidelines | NIH". clinicalinfo.hiv.gov. US HHS. 29 July 2024.
  34. ^ "David R. Boulware, MD, MPH". The American Society for Clinical Investigation.
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