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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

#141

Post by ajross »

esyir wrote: post #134
ajross wrote: post #85

Earlier quoted context omitted.

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.

And this we now have the opposite problem, where a potential option is treated like it has the legitimacy of crystal healing, depending on the political side you sit on.

Sorry, who exactly is likening chloroquines to crystal healing? I hear this all the time, but frankly it's a giant strawman. No one serious (i.e. a public figure with media coverage) is arguing against the efficacy of chloroquines.

Boosting unproven drugs is dangerous and irresponsible, and arguing that fact is not the same thing as arguing that the drug is ineffective.

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

#142

Post by _ea1k »

CydeWeys wrote: post #114
_ea1k wrote: post #71

Earlier quoted context omitted.

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.

What is the comparison being made here? Endorsing the frontrunner for political candidacy isn't remotely the same as endorsing an unproven drug to treat an ongoing pandemic.

Noone endorsed an unproven drug.

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

#143

Post by nkozyra »

twomoretime wrote: post #127

It really bothers me how hard both citizens and officials seem to be wanting Chloroquine to fail all because somebody they didn't like endorsed it publicly. Can't let him have that win, right? Like children. The original studies that showed promise used combinations of Chloroquine, Azithromycin, and or zinc, and there is a speculated pathway by which these drugs interact to interfere with COVID replication. This stud…

I think there's a bunch of strawmen here. It's disingenuous to say that people who found [said person]'s comments to be a bad idea want it to fail.

Indeed, if that person had come up and said "there's a lot of promising treatments, such as ..." or "the experts are telling us that some studies involving [x, y, z] are showing some positive signs" or something of that ilk, nobody would have cared. Instead, the person multiple times touted something that is to date unproved. People find that irresponsible for a number of reasons, not least of which that there are legitimate users who need this and it's now in short supply.

So what people are protesting is someone not waiting for medical science and just causing noise.

Like many things, this person could have handled this all more responsibly.

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

#144

Post by gameswithgo »

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%…

It is important to remember we also do not have evidence of no efficacy for chocolate milk.

Yet we do not waste our time testing it.

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

#145

Post by SlowRobotAhead »

lonelappde wrote: post #80
koheripbal wrote: post #34

Earlier quoted context omitted.

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"

As insane as that is.

And how funny is it (at least to me) that this is only because Trump came down on one side initially. If he had come out saying exactly the opposite, that HCQ was bad and we should be skeptical, everyone hoping it doesn’t work now would be looking for the 10 person studies saying it totally works and defending its use.

It’s almost beyond reason how hyper partisan this specific issue is.

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

#146

Post by lbeltrame »

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…

> There's also the fact that study makes it less likely that pre-hospitalization HCQ will have any effect either.

We'll see with the U of Minnesota trial, which attempts to use it as post-exposure prophylaxis. Data (hopefully) will tell us.

On favipiravir, the data on the Chinese study wasn't exceptional, but wasn't that bad either. Perhaps the Japanese phase 3 study will be more enlightening.

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

#147

Post by _ea1k »

vernie wrote: post #140
_ea1k wrote: post #71

Earlier quoted context omitted.

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.

"But I think people should — if it were me — in fact, I might do it anyway. I may take it. Okay? I may take it."

Biden "may work, then again, [...] may not work." - Is that an endorsement?

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

#148

Post by forgingahead »

This whole debate is insane to me -- some people that so-called "experts" don't like mentioned HCQ as a possible treatment for coronavirus, and we've ended up in some bizarro world where everyone is shouting and fingers are being pointed over something that really shouldn't be controversial or perceived as some sinister plot to destroy clever society.

1. HCQ has been used for many decades

2. The side effects are generally known

3. It may have a positive impact on COVID-19, and it may not.

4. Nobody is suggesting long term high doses for anyone, COVID patients or otherwise.

5. If people are severe patients of COVID-19, this should certainly be tried as a treatment as long as the patient (or immediate family) is briefed on the potential side effects. The alternative, potential death, makes this a worthy discussion for a doctor/patient to have, with families being allowed to err on the side of right-to-try. HCQ is cheap, available, and has been used for decades.

The fact that "no evidence HCQ works!!" has 200 points of upvotes and counting when the sample size for this study is 181 patients only just shows how high the temperature has become.

Everyone just calm down. As capnrefsmmat has eloquently pointed out, "absence of evidence" does not mean "evidence of absence".

If you enjoy the thrill of debates for debates sake, here are other potential topics for you: Whether masks are effective, condoms, seatbelts, helmets, or even parachutes[0]:

[0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/

Favourite part:

Results We were unable to identify any randomised controlled trials of parachute intervention.

Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

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

#149

Post by Mtinie »

DiogenesKynikos wrote: post #96
majormajor wrote: post #61

Earlier quoted context omitted.

> 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.

This matches what I've read, too. It's less about the virus during the later stages and more about the infected person's immune system. If they've entered a state of amplified immune response, colloquially called a "cytokine storm," organs are damaged when their cells are mistakenly attacked.

If you can moderate the immune system's reaction you can prevent significant damage. HCQ is useful for this type of immuno-suppression.

Here's a pre-print of an article from a few years back which talks about HCQ and cytokine storms:

Scott W. Canna, Edward M. Behrens. Making Sense of the Cytokine Storm: a conceptual framework for understanding, diagnosing and treating hemophagocytic syndromes. Pediatric Clinics of North America [Preprint]. April 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3368378/

Published article link: https://dx.doi.org/10.1016%2Fj.pcl.2012.03.002

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

#150

Post by rozab »

3fe9a03ccd14ca5 wrote: post #132
bcrosby95 wrote: post #111

And to put this interpretation into perspective, people that need this drug for diseases that it has proven to have a large effect on are losing access to it because it may or may not help with COVID-19.

HCQ is an off-patent drug that is produced in every major country in the world. In fact, many countries have stockpiles of it because of its efficacy at preventing malaria. If there’s a risk of a supply run, it would definitely not last very long. For many people there’s alternatives for treating arthritis and lupus. If it’s shown even to improve the patient’s outcome by even just 10% or more (as this study suggests)…

Face masks have been shown to be effective at controlling pandemics, and apparently no one (in many western countries) thought to stockpile those.
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