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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

#171

Post by bluGill »

tobessebot wrote: post #160
bluGill wrote: post #95

Earlier quoted context omitted.

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

I can personally discount everything he says, that doesn't make it any less legitimate to say that the President of the United States shouldn't hold press conferences in which he over-hypes the proven effectiveness of certain drugs during a pandemic. Otherwise anyone can just claim anything whenever they want without any proof whatsoever.

One must live in the world as it is, not as we wish it would be. Thus we need to consider actions, words and results separately.

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

#172

Post by DangerousPie »

forgingahead wrote: post #148

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 gene…

1. Not for coronaviruses.

2. They are known but they are by no means mild. A trial in Brazil just got aborted due to severe heart problems.

3. So does almost everything. If that's your threshold for taking a drug then I have a lot of homeopathic remedies to sell you!

4. Actually the doses given for COVID are often higher. Not sure what long-term has to do with anything.

5. That assumes that the risk of side effects is zero. It's not. Also, there is an opportunity cost to taking HCQ instead of something else.

I totally agree with you that we should do proper trials on this and see what happens. But right now there is zero evidence that it actually works, and some (admittedly low-quality) evidence that it might not.

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

#173

Post by tjenkinsqs »

forgingahead wrote: post #148

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 gene…

Excellent points.

I would add: HCQ is most effective at the onset of symptoms. It stops the virus from replicating, it does not repair cell damage. Also, it must be used with zinc together, since HCQ opens the cells to absorb zinc and zinc must be present.

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

#174

Post by gvjddbnvdrbv »

smacktoward wrote: post #124
johntb86 wrote: post #63

Earlier quoted context omitted.

Remdesivir could be great, and there are a lot of studies ongoing about it. However, it has a long production time - Gilead says 6 to 8 months: see https://www.gilead.com/purpose/advancing-global-health/covid... . They're only projecting to have 500,000 treatment courses by October, so it could only help a relatively small fraction of the people that will have coronavirus.

Even a small volume of an effective treatment could still be helpful. Usage could be restricted just to patients with cases serious enough to otherwise require ventilators, for instance, which would both ease the strain on limited ICU resources and save lots of people who would otherwise die (since only around 10-30% of ventilated patients survive even with that treatment).

But antivirals tend to need to be given early to have a good effect. How will be know who is going to be severe?

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

#175

Post by Goronmon »

downerending wrote: post #56
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 pushed it as a miracle cure, at least at one point, and he evokes bitter opposition in many. (I think this is quite irrational, but that's your answer.)

People are in opposition to the president promoting drugs with unproven effectiveness as a miracle cure for an ongoing pandemic.

I didn't think testing drugs before giving them to people was considered "irrational" as you state, but I guess that is where we are now.

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

#176

Post by eesmith »

beaner wrote: post #161
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.

Is there a source for this claim?

Wikipedia links to two WaPo articles at https://en.wikipedia.org/wiki/Hydroxychloroquine#Regulatory_...

Guardian article - https://www.theguardian.com/world/2020/mar/27/vital-drug-peo... .

It cites someone from Lupus UK. Their page at http://www.lupusuk.org.uk/uk-azathioprine-supply/ says "we have received reports from a number of people with lupus who have been unable to fulfil their prescription of azathioprine" and that "stocks are in the process of being replenished and should be available in the UK in mid-April".

Comment from an HN'er:

"For several weeks my mother hasn't been able to fill her regular prescription for hydroxychloroquine that has been an important part of managing her lupus for >30 years." - https://news.ycombinator.com/item?id=22793293

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

#177

Post by marcosdumay »

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"

This is the kind of study where it would be beneficial for it to be ignore. The correct headline is no headline at all.

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

#178

Post by cscurmudgeon »

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"

"Weak evidence for effectiveness of hydroxychloroquine but our sample was likely too small for it to pass a T-test but it has a compound that was championed by a politician so it will be trumpeted far and wide by those who don't understand any of it and it will trampled upon similarly by those who don't understand any of it. "

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

#179

Post by thepangolino »

mcguire wrote: post #129
pcj-github wrote: post #76

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?

Hydroxychloroquine is an immune suppressant and may help reduce the cytokine storm effect. How that interacts with the "you have to start it early" issue is unclear to me. And it might keep you from getting malaria while you have COVID19.

The way HCQ is by accumulating in cells. It inhibits the replication of viruses by interfering with endosome/lysosome trafficking or viral protein maturation during virion maturation. (basically stops the virus from replicating)

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

#180

Post by URSpider94 »

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)…

It's already been politicized, it's too late. The minute that politicians started advocating for a treatment before there was any scientific backing, that ship sailed.

Also, this study does NOT suggest that patient outcome is improved by 10% or more. Not in any way. Fewer patients died within the timeframe of this study, but more patients on the drug experienced ARDS; not to mention that 9 patients had to be removed from the study due to cardiac effects of the drug.

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