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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

#91

Post by DataWorker »

mcguire wrote: post #81
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. "

Wouldn’t ecg changes be plausibly the result of the virus itself? I haven’t read the paper so maybe they go into greater detail but it would be important to know whether such changes were seen in the control group as attrition/discontinuance is critically important to any study.

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

#92

Post by the_af »

winstonewert wrote: post #51
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?

Trump said positive things about it. The left wants Trump to be wrong about everything, so wants this it to fail. The right wants Trump to be right about everything, so wants it to work.

I seriously doubt anyone on the planet right now (short of being deranged) wants a treatment not to work.

I understand wanting to chastise Trump for being exaggerated and reckless about an unproven treatment, but wanting it not to work? That can't be true.

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

#93

Post by mcguire »

_ea1k wrote: post #71
AlexandrB wrote: post #29

Earlier quoted context omitted.

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.

I'm not at all sure I would like millions of doses of Joe Biden to be placed in the federal stockpile of emergency medical supplies, even if those doses were for the sole use of the federal government. It sounds kind of expensive and I don't think anyone knows what the effect of Joe on the coronavirus actually is.

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

#94

Post by tomohawk »

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.

And then what happens next time? Why spend all the time and effort, only to have what you did nationalized?

Incentivizing people to not do productive things like develop drugs seems like a really bad idea.

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

#95

Post by bluGill »

tobessebot wrote: post #77
phkahler wrote: post #65

Earlier quoted context omitted.

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.

Trumps history of exaggeration goes before and anyone sane accounts for it.

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

#96

Post by DiogenesKynikos »

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?

From what I understand, in the late stages of the disease, it's not necessarily the virus that's killing the patient. Often, the virus has been cleared and it's the patient's own immune response that's doing the damage.

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

#97

Post by shadowgovt »

mcguire wrote: post #81
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. "

Question: are the induced arrhythmias permanent or do they discontinue when HCQ therapy discontinues?

I'm curious as to the permanency of the damage.

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

#98

Post by Symmetry »

CydeWeys wrote: post #22
julioo wrote: post #8

Point is that the study is done at the wrong stage, too late.

That may be, but it's gonna be harder logistically to do a study commencing from onset of symptoms vs at moment of hospitalization. There's also the fact that study makes it less likely that pre-hospitalization HCQ will have any effect either. Applying a Bayesian analysis here, it's now likelier that the true ground truth is simply that HCQ doesn't do anything to COVID-19 at all, not necessarily that it works only in…

The study that made me think there might be something to it was looking at people taking it for unrelated illnesses and finding that they weren't tending to show up hospitalized with Covid-19.

I'd agree that we really don't have any evidence that giving it to hospitalized patients helps at all. Most antivirals have to be taken at the early stages of an infection.

The best looking treatment for people seriously ill with Covid-19 right now seems to be IL-6 inhibitors. That won't stop you from getting sick but might let you avoid intubation.

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

#99

Post by mcguire »

jeffdavis wrote: post #62

Given the study's small sample size, it seems the only way it would have produced a conclusive result is if the effect size was huge (i.e. miracle cure). The study found some evidence of efficacy, but it was not significant given the sample size. A better headline would say something like: "study finds that HCQ is not a miracle cure for already-hospitalized covid-19 patients".

How much are you willing to pay for "not a miracle cure" on the basis of "eh, it can't hurt"?

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

#100

Post by hjnilsson »

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)

Remdesivir (and other antivirals / T-inhibitors on trial) are all extremely difficult to manufacture (and expensive) compared to hydroxychloroquine. Most hospitals and countries will be unable to acquire the amounts required for even small trials. It will be many months before we can begin to see results for these drugs.
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