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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

#231

Post by Goronmon »

downerending wrote: post #205
Goronmon wrote: post #175

Earlier quoted context omitted.

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.

It's "irrational" to oppose an idea just because it comes from someone you despise. It's not like this is coming from the National Enquirer --he has access to some of the brightest minds in the world. The efficacy picture on these drugs is quite confusing, and it's not out of the question that they will turn out to be crucially useful. Giving up on them without further investigation doesn't seem wise at this point. B…

It's "irrational" to oppose an idea just because it comes from someone you despise.

Giving up on them without further investigation doesn't seem wise at this point.

I don't disagree with these ideas on the surface, but they seem largely strawmen-style arguments. I'm not convinced a significant number of people somehow "hate" hydroxychloroquine or are against research solely on the basis that Trump mentioned it.

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

#232

Post by roywiggins »

tomohawk wrote: post #192
smacktoward wrote: post #130

Earlier quoted context omitted.

Nobody’s saying Gilead can’t make a profit. Just that they can’t make an obscene (“have us over a barrel”) profit.

The post I was responding to had the strong implication of a Mafiosi stopping by a store and saying "Nice store you have here - it would be a shame if something happened to it". "You might want to consider our needs and sell us stuff at what we consider a good price".

That's how the USA behaves literally all the time with other countries and foreign companies. It seems like a weird time to choose to play nice for once?

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

#233

Post by fzeroracer »

downerending wrote: post #205
Goronmon wrote: post #175

Earlier quoted context omitted.

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.

It's "irrational" to oppose an idea just because it comes from someone you despise. It's not like this is coming from the National Enquirer --he has access to some of the brightest minds in the world. The efficacy picture on these drugs is quite confusing, and it's not out of the question that they will turn out to be crucially useful. Giving up on them without further investigation doesn't seem wise at this point. B…

Let's say Trump instead proposed that people taking, I don't know, silver supplements was a proper treatment for covid-19.

Would you say it's irrational to oppose that idea? I mean it's not been proven to not work, so you gotta try anything you can, right? And he's giving people hope.

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

#234

Post by dhimes »

magicalist wrote: post #182
thedudeabides5 wrote: post #75

Earlier quoted context omitted.

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"

> 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" It would be irresponsible to choose an experimental design (like significance level) and then use wishy-washy language ("weak evidence") to work around it when the study criteria aren't met. This would be more akin to the headline fro…

In the US the phrase "tongue-in-cheek" means "kidding."

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

#235

Post by rsynnott »

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…

> It really bothers me how hard both citizens and officials seem to be wanting Chloroquine to fail

No-one wants it to fail. However, right now there's no reason to think that it is useful, and the sooner there's a definitive answer either way the better. Certainly, no-one should be taking it outside trials right now, and the ambiguity (and unreasonable hope stoked by high-profile idiots) is causing people to take it, often without medical supervision. This will kill people.

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

#236

Post by atourgates »

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…

Are any large(r) scale trials incorporating Azithromycin as well?

The "most promising" study I saw early on was this one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102549/ - which seemed to suggest that the combo eliminated the viral load in 3-5 days.

The only followup study I've found was this one: https://www.medrxiv.org/content/10.1101/2020.04.08.20054551v... - that urged caution with the combo because of a possibility of increased heart failure.

Obviously, that's a very small study with

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

#237

Post by apendleton »

dessant wrote: post #50
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…

> Estimated Primary Completion Date: April 1, 2021 Can we expect preliminary data from this trial before the primary completion date?

Yes, different arms will have data available at different times. The prophylaxis one might take longer than the others, but for the ones involving sick people, once they hit their target enrollment (which probably won't take long at all), those people will either get better or they won't.

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

#238

Post by chasd00 »

thepangolino wrote: post #179
mcguire wrote: post #129

Earlier quoted context omitted.

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)

and, correct me if i'm wrong, zinc helps

take it with a grain of salt but https://www.snopes.com/fact-check/zelenko-669-coronavirus-pa...

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

#239

Post by TeMPOraL »

renewiltord wrote: post #208
DangerousPie wrote: post #191

Earlier quoted context omitted.

How is this about regulation? Factories and supply chains can't just suddenly ramp up their production by an order of magnitude or more. You need to build new machines, hire new workers, source new supplies, and figure out how to distribute it all. That can't just happen from one day or another, no matter how little regulation there is on the product.

You’re overestimating the difficulty of this. But don’t trust me. Go talk to a generics drug manufacturer in India yourself.

> Go talk to a generics drug manufacturer in India yourself.

You mean the country that, more than a month ago, restricted exports of many drugs and chemicals used to make drugs (the so-called Active Pharmaceutical Ingredients). Your local end of the pharmaceutical supply chain can't deliver drugs that can't be made anymore.

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

#240

Post by radford-neal »

URSpider94 wrote: post #195
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 not the bar that's typically applied for drug trials. The goal of a drug trial is not to prove beyond a shadow of a doubt that it DOESN'T work. The goal is to prove to a high level of confidence that it DOES work. For example, it's highly unlikely (roughly less than 2.5%) that HCQ reduces the onset of ARDS by half. If it ultimately turns out that HCQ reduces the rate of death by 5%, we'd have to do a tremendo…

This is not a typical drug trial.

Typical trials are designed to have a large enough sample size that they will be able to detect any effect big enough to be clinically important.

Here, they just went with the sample size they had available (understandably), which was so small that only a very large effect could be clearly established. It is completely wrong to interpret the lack of a statistically significant effect with this small sample size as showing that the drug doesn't work.

Consider the result regarding transfer to ICU or death:

   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)
The best estimate is for 9% less risk from using the drug, with the possibility of the drug cutting the risk by more than half not being excluded in the 95% confidence interval. Of course, the possibility that the drug actually makes things worse is also not excluded, but this can certainly not be characterized as proving that the drug doesn't work.
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