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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

#81

Post by mcguire »

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%…

The rest of the statistics:

"In the weighted analysis, 20.2% patients in the HCQ group were transferred to the ICU or died within 7 days vs 22.1% in the no-HCQ group (16 vs 21 events, relative risk [RR] 0.91, 95% CI 0.47-1.80)."

And...

"Eight patients receiving HCQ (9.5%) experienced electrocardiogram modifications requiring HCQ discontinuation."

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

#83

Post by lonelappde »

munk-a wrote: post #52
frgtpsswrdlame wrote: post #37

Earlier quoted context omitted.

Because this drug can be cheaply manufactured out of patent. Let's say Remdesivir is the only drug that works, it's basically an admission that Gilead is going to have us over a barrel.

Only if we chose to let them bend us over said barrel? The US government could simply seize the patent if Gilead acted in a manner against the public good.

The US government is not "we", even if we are in the US.

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

#84

Post by DrNuke »

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%…

Magic potions do not work, we all should know that in 2020 and wait for the scientific trials step by step... as for corona, today the most promising way before a vaccine, if any, is tailored therapy aimed at containing symptoms so that your body and immune system can fight off the virus at full strength... and we are starting to see a great number of cases that actually improve and can help similar cases (for age, sex, comorbidities, etc.) worldwide, so more hope today than one month ago even if infection numbers are still rising up.

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

#85

Post by ajross »

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 absolutely true. But the reason that a bland non-result is newsworthy is precisely because various public entities decided to treat the previous result as much more significant than it was. And it absolutely does serve as a refutation of that rhetoric.

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

#86

Post by layoutIfNeeded »

onlyrealcuzzo wrote: post #35
wyxuan wrote: post #30

This trial wasn't randomized, but a quasi randomized trial for HCQ whose preprint was leaked is here: https://www.dropbox.com/s/8b2govfsa6n0xbq/NEJM_Clinical%20Ou... Study indicates that one adverse effect of HCQ (on top of not improving patient outcomes) is increased ventilator times.

From the paper: A total of 63 patients were included with 32 in the hydroxychloroquine arm. Hydroxychloroquine administration was associated with a need for escalation of respiratory support level compared to those that did not receive hydroxychloroquine at 5 days (p=0.013). The same findings were observed in a baseline-matched subgroup analysis. Absolute lymphocyte change in the hydroxychloroquine group was no diffe…

    p=0.413
    p=0.51
So, basically coin toss?

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

#87

Post by briefcomment »

thedudeabides5 wrote: post #75
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"

Wow, I would love titles like this.

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

#88

Post by bluGill »

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?

That isn't the same as the studies are likely to be different. If one study is old people, another young, another those with diabetes, and so on. Some may have data but it is clouded by a biased sample...

Putting this all together is done in meta analysis which is complex and finds things in small studies that don't show up but it isn't trivial to do them.

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

#90

Post by firasd »

massaman_yams wrote: post #79
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…

The problem with 'low risk / high upside' is that it can apply to anything. We can try lemonade since it has low risk and high upside. But at some point we have to start wondering if we should all be obsessed with lemonade right?

Even when doctors were using HCQ before the politicians and random outsiders picked up on it, there were other drugs in the mix that they were also considering (Lopinavir, Remdesivir, etc). Incidentally Remdesivir trials have also come out lately seeming pretty weak. But there is still nowhere near the level of frenzy around Remdesivir as there has been around HCQ to the extent of advocacy at White House press briefings, international diplomatic incidents... it's beginning to seem like a very strange mass hallucination.

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