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Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

medrxiv.org

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Re: Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

#71

Post by _ea1k »

AlexandrB wrote: post #29
w_t_payne wrote: post #23

Given that I need hydroxychloroquine to treat my rheumatoid arthritis, I'd like this hypothesis to be either proven or disproven as rapidly and as unambiguously as possible.

Because HCQ’s efficacy was briefly endorsed by a controversial political figure I fear that there’s no evidence in either direction will convince the true believers. This is now a political issue, like global warming. Hopefully someone is ramping up production so availability improves for those that actually need it.

Imagine if Obama had "endorsed" Biden using the same language. Would you have considered it an endorsement? I find the interpretation of what he said to be very peculiar.

Re: Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

#72

Post by VBprogrammer »

the_af wrote: post #46
war1025 wrote: post #43

Earlier quoted context omitted.

> Lots of conflicting research happening That's my main take-away at this point. I have seen enough reports saying it worked, and enough saying it didn't that I believe the answer is probably somewhere in the middle. My understanding is the best guess for how it works is by keeping the viral infection from becoming serious enough to require hospitalization. Similar to how proper treatment of wounds early on keeps the…

I'm out of the loop here: why would any political faction not want an alleged cure to work? What's the goal here?

Trump all but prescribed it to the nation a miracle drug "a real chance to be one of the biggest game changers in the history of medicine".

Questioning the wisdom of that, given how little we knew, is seen as a partisan attack on Trump.

Re: Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

#73

Post by anoncareer0212 »

majormajor wrote: post #61
apendleton wrote: post #15

Personally I'm witholding judgment until the results of the PATCH trial ( https://clinicaltrials.gov/ct2/show/NCT04329923 ) arrive, as it'll finally give us some decent statistical power, and be a full, double-blind RCT. It also has multiple study arms (health-care worker prophylaxis, home-quarantined early stage, hospitalized later-stage), so if it turns out that HCQ is effective but that by the time patients are ho…

> so if it turns out that HCQ is effective but that by the time patients are hospitalized it's too late What's the mechanism supposed to be here? If it suppresses replication of the virus, shouldn't that be effective up to close to the point of death - once replication is slowed enough, viral load should fall off, and recovery should happen?

Hydroxycholorquine is an immunosuppresant not an anti-viral, so the theory here is the problem isn't the virus, but reacting to it. It's not quite as silly as it sounds - this does, rarely, work, specifically with malaria. But, it is pretty silly when you contrast the likelihood of it being a meaningful thereapeutic versus the significance it's taken on

Re: Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

#74

Post by lonelappde »

blakesterz wrote: post #69
capnrefsmmat wrote: post #49

It's important to interpret these results carefully: "no evidence of efficacy" does not imply evidence of no efficacy, and in fact the uncertainty in this study is quite large. The sample size is small enough that it would be very hard for this study to detect the effect of hydroxychloroquine unless that effect is very, very large. From the abstract: > In the HCQ group, 2.8% of the patients died within 7 days vs 4.6%…

Would it be the same thing to do 1,000 small studies like this one as doing one LARGE study with 1000x more people? Would the results be considered just as useful?

Similar. That's called a "meta analysis" and tends to happen after many independent uncoordinated small studies have published.

Re: Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

#75

Post by thedudeabides5 »

capnrefsmmat wrote: post #49

It's important to interpret these results carefully: "no evidence of efficacy" does not imply evidence of no efficacy, and in fact the uncertainty in this study is quite large. The sample size is small enough that it would be very hard for this study to detect the effect of hydroxychloroquine unless that effect is very, very large. From the abstract: > In the HCQ group, 2.8% of the patients died within 7 days vs 4.6%…

This is a great comment thanks.

Title of the paper could (with a tongue firmly in cheek) be called, "Weak evidence for effectiveness of hydroxychloroquine but our sample was likely too small for it to pass a T-test"

Re: Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

#76

Post by pcj-github »

Aside from these results, what is the proposed mechanism of benefit here?

And why are we expecting a mechanism with hydroxychloroquine against this virus when essentially no small molecule therapies are effective against viruses in general?

Re: Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

#77

Post by tobessebot »

phkahler wrote: post #65
the_af wrote: post #46

Earlier quoted context omitted.

I'm out of the loop here: why would any political faction not want an alleged cure to work? What's the goal here?

President Trump encouraged trying hydroxycloroquine early on when there were early indications it might work. The problem is that he is considered such a villain by the left that they want it not to work just to prove him wrong. Such is the state of politics in the US. IMHO he was right to lean on the FDA to find out if its effective. Since it's already available, it would make sense for doctors to try it, but most a…

The problem wasn't that Trump encouraged trying it, but that he clearly exaggerated what we knew about its effects and continued to do so for a long time even after having been confronted about it.

Re: Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

#78

Post by mikepurvis »

programmarchy wrote: post #57
kazinator wrote: post #38

Earlier quoted context omitted.

You want it disproven, otherwise you won't be able to get your hands on hydroxychloroquine.

Why couldn't we just manufacture more?

That's happening regardless, but yeah: https://www.google.com/search?q=hydroxychloroquine+manufactu...

Re: Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

#79

Post by massaman_yams »

firasd wrote: post #41

When the Covid crisis is over, one of the strangest sub- plots will have been the fracas around Hydroxychloroquine. Starting from medical practitioners worldwide adopting its usage in a ‘cargo cult’ way, mimicking what other doctors were doing, to Raoult’s low- quality study. Then people in Silicon Valley (notably Elon Musk) picking up the idea. Followed by the explosion in the political sphere, from Trump pushing it…

Politically, yes, there was/is a cargo cult. Both for those convinced it's a cure, and the anti-cargo-cult opposing party convinced it's somewhere between useless and actively harmful.

From a medical practice standpoint, you have a widely-available drug with well-known side effects that can be administered in a medical setting with low risk, and potential life-saving upside. When the research is early but potentially promising, it's not irrational to administer in cases where the side effects should be well-tolerated, even if later research shows no or low benefit.

The problem arises from self-administration without medical supervision, or with inadequate medical supervision.

Re: Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

#80

Post by lonelappde »

koheripbal wrote: post #34
apendleton wrote: post #15

Personally I'm witholding judgment until the results of the PATCH trial ( https://clinicaltrials.gov/ct2/show/NCT04329923 ) arrive, as it'll finally give us some decent statistical power, and be a full, double-blind RCT. It also has multiple study arms (health-care worker prophylaxis, home-quarantined early stage, hospitalized later-stage), so if it turns out that HCQ is effective but that by the time patients are ho…

Yeah, the devil is really in the details about exactly when and how you administer it. Doctors are already saying that it's definitely no magic bullet, but they debate whether it is effective at a certain stage of illness. What I don't understand is why we're focusing so much on this specific drug when there are some great antivirals out thee that have a more effective theoretical mechanism of action. (eg Remdesivir)

Because it's become an arbitrary political football to separate "left" vs "right"
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