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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

#221
post #150

Earlier quoted context omitted.

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.

During the H1N1 crisis France made a strategic reserve. Latter governments reduced the inventory. It was not renewed in the end.

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

#222
post #147
post #140

Earlier quoted context omitted.

"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?

"What do you have to lose? Take it,"

"I sure as hell think we ought to give it a try."

"one of the biggest game-changers in the history of medicine"

"I want people to live and I’m seeing people dying and I’m seeing people who will die without it,"

These statements are just the tip of the iceberg when it comes to endorsements by Trump.

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

#223
post #92

Earlier quoted context omitted.

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.

A proven successful use of this drug would be very inconvenient for multiple media outlets who jumped at the (described as) unfounded claim. It would mean that either (a) the authorities had more information than they did, or that (b) the authorities bet successfully with the same amount of information, which doesn't align with their constant reporting of idiocy.

> A proven successful use of this drug would be very inconvenient for multiple media outlets who jumped at the (described as) unfounded claim.

Eh? Even if it did turn out to work, it would still have been an unfounded claim for Trump to claim it did without evidence, and a stupid and dangerous thing to do. That's what 'unfounded' means.

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

#224
post #71

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.

My mother, a pharmacist by training, has repeatedly communicated her impression that "this whole coronavirus thing would be gone in a week if we just gave everyone HCQ!"

She got that impression from somewhere, but certainly not from any of the studies I've read, leaving the conservative news sphere as the likely source. Whoever is making the exaggerations, they're egregious.

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

#225
post #95

Earlier quoted context omitted.

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.

So everyone, including frightened elderly people, is supposed to have a prior that the president is a liar and should be ignored, and thus it is acceptable for Trump to say what he wants? That's a frankly bizarre approach.

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

#226

Earlier quoted context omitted.

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?

By the time we have lots of it, we will have good statistics on demographics of people most likely to need it, so you could make educated guesses and still see a benefit.

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

#227

Earlier quoted context omitted.

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?

> was no different than supportive care alone (p=0.413).

Yes, exactly, p=0.413 corresponds to a coin toss, or as the authors of the paper put it "no different".

The p=0.51 figure seems to be a typo in the abstract. If you read the content of the paper, it says

> The hydroxychloroquine group also had a strong but not statistically significant trend towards worsening NLR (p=0.051).

So I believe they just accidentally moved the decimal place, and they are correctly avoiding calling the result statistically significant, but it is close.

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

#228
post #150

Earlier quoted context omitted.

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.

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

You're dropping the context of the hard decisions nations and governments actually deal in day to day, year to year when it comes to budgets. That's why not a single country had a proper stockpile of N95 masks for a pandemic like this. That isn't an exaggeration: literally not one nation had enough of a stockpile for this scenario, that includes South Korea, Japan, China.

To say that nobody thought to do it is outlandish. As one example Congress set aside funds in 2006 to stockpile 100 million N95 masks. That's not strange, as many people were aware of the need to maintain such a stockpile. There is a big difference between being aware of the need, proposing plans and spending for it, and actually getting billions of dollars on a recurring basis to maintain the necessary proper stockpile perpetually with no event to push it with (yeah but we had a flu pandemic in 1957! try selling that premise). That's the actual reality of budgets and governments.

It's expensive to maintain a persistent minimum stockpile of 1 billion non-expired N95 masks to cover the US population and the demand the US has seen. If it's a year-long pandemic, a billion masks isn't enough. You need several billion masks in that scenario. Coming out of the great recession, that is a very hard budget decision for all nations. And the fact is, most nations can't afford to do it at all. The easy retort of course is to say, well, look at the damage from this virus compared to that cost for masks. That's purely hindsight spouting that tries to pretend a comprehensive reality doesn't exist and that people who make budgets don't have to deal with difficult decisions every single year (while not factoring in every possible bad scenario every time they make a budget).

And let's not pretend it's enough to stockpile masks, regarding spending allocations. If we're doing hindsight fantasy, let's be correct about it. You need to constantly maintain a lot of other gear and training for a pandemic, costing large sums of money. In an ideal scenario a nation the size of the US should probably have over a million ventilators stockpiled, just in case. We should probably maintain 2x or 3x the ICU capacity we have, on a persistent basis and at a large cost.

This isn't an argument against being more prepared. Of course every nation should have a vast magical stockpile of N95 masks that never depletes, even the ~140 poor nations of the world that can't afford to do it. The point is, it's difficult to convince any nation to do it at the required persistent scale, and most can't afford to do it regardless.

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

#229
post #150

Earlier quoted context omitted.

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

During the H1N1 crisis France made a strategic reserve. Latter governments reduced the inventory. It was not renewed in the end.

The US likewise had a reserve until it was depleted in 2009 and never replaced https://www.bloomberg.com/news/articles/2020-03-18/hospital-...

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

#230
post #26

It was observed that between 7% and 28% of hospitalized have acute myocardial injury [1-4]. When one looks at Epocrates (database for drugs which is why I'm not linking anything here) the severe adverse reactions of hydroxycholoroquine include QT prolongation, cardiomyopathy, and torsade de pointes. Just to define some things here, QT prolongation is the time from your Q wave to your T wave, or the start of an electr…

> between 7% and 28% of hospitalized have acute myocardial injury So, for a younger (< 60) otherwise healthy person whose chance of death with covid is less than 1%, it would seem ill advised to take this medication at the onset of symptoms, unless the the disease itself causes similar or higher rates of heart damage.

Taking random drugs that you read about on the internet, rather than under medical advice, is almost always a bad idea.
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