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Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

medrxiv.org

241–250 of 379 posts

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

#241

Earlier quoted context omitted.

Because it's become an arbitrary political football to separate "left" vs "right"

Honestly, if this were not linked so tightly at this point to a certain U.S. politician, then I doubt that it would receive much media attention at all. And it would probably be the sort of thing that HN and Reddit would view favorably.

It would be same as Remdesivir, nitric oxide, and favipiravir. They all have clinical trials going on and anecdotal evidence of efficacy . Most people have never heard of any of these treatments. Like most drug trials, they will probably show a limited or no improvement over the control group. We can get our hopes up, but we should be planning that there will be no effective and/or viable treatment deployed before a vaccine is released.

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

#242

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%…

> "no evidence of efficacy" does not imply evidence of no efficacy That's incorrect. Absence of evidence is evidence of absence. It's just not proof of absence. See https://www.lesswrong.com/posts/mnS2WYLCGJP2kQkRn/absence-of...

By that logic, you could just not do the study at all and claim it as evidence of absence. Statistically, it's the same problem. You need data (and lots of it, relative to the noise) to provide evidence of anything.

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

#243
post #142

Earlier quoted context omitted.

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.

https://twitter.com/realDonaldTrump/status/12413672399007785...

HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine. The FDA has moved mountains - Thank You! Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents).........be put in use IMMEDIATELY. PEOPLE ARE DYING, MOVE FAST, and GOD BLESS EVERYONE! @US_FDA @SteveFDA @CDCgov @DHSgov

That's not an endorsement?

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

#244
post #234

Earlier quoted context omitted.

> 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."

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

I took that to mean they obviously weren't suggesting something so conversational as the actual title, but the takeaway is the same and shouldn't be a conclusion taken from the OP comment.

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

#245
There are dozens upon dozens of speculative treatments. Interactome research is churning out candidates.

I think the people have a right to know about cloroquine, since it became such a political point. But n=181 is not that small.

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

#246
post #214

Earlier quoted context omitted.

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" an…

Is this shortage universal? Have there been shortages before, either universal or local? Is there evidence that this particular local shortage is due specifically to coronavirus demand? It may be that the answer to these questions is "yes," but that answer seems to be being assumed right now.

I believe my citations answer your questions sufficiently.

Since the questions #1 and #2 can be answered both "yes" and "no", with equal merit, I suggest that perhaps they are not useful questions.

That is, not every pharmacy in every country is out, and sometimes a pharmacy is out of a medicine. If that's what you mean by "universal" and "local shortage before" then you're being absurd.

Bear in mind that I was answering beaner's question, not making some broader statement.

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

#247
post #155

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 easy to make, there's tons of it lying around already, and it doesn't need human safety trials (we already know safe dosages). If it works, it'll be a near-miracle.

No, that explains the initial attention, not the sustained attention in the face of clear and severe problems it is now getting.

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

#248

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%…

[deleted]

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

#249

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?

There's some evidence now that viral load peaks in the first week, and it's the second week that tends to be a problem for people with very serious cases. By the time many of these patients are hospitalized, their viral load is already going down on its own, and their serious complications are either due to immune overreaction (the so-called "cytokine storm"), or some sort of opportunistic co-infection like bacterial pneumonia.

It's decently likely from what I've been reading that there might end up being effective pharmaceuticals for each stage, but that they'll be totally different from one another: maybe HCQ and antivirals like remdesivir or favipiravir early, and maybe immune-modulators like tocilizumab or even corticosteroids in this second phase. But again, the devil will be in the details, as it looks like HCQ doesn't work late, and steroids or other immune modulators might be actively harmful in that first stage when the virus is still surging.

As for mechanism: nobody is really sure. HCQ does have some immune-modulating effects (that's what makes it useful for lupus), but there's also speculation that it might have some effect on the interaction between the ACE2 receptor and the coronavirus spike protein, and so somehow inhibit viral entry (see, e.g., https://www.nature.com/articles/s41421-020-0156-0).

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

#250
I think it's too bad that this drug has been so politicized. It's really unfortunate that its two original and most prominent champions are people that are so disliked. So many people spoke up (maybe prematurely) against it in a knee-jerk reaction to its advocates. Now many act as if they're more concerned about being right to ridicule the claims all along, than they are about whether the drug is actually helpful in fighting COVID-19. Which, for the rest of us without a stake in their stupid political feuds, is all that matters. And because of this idiotic battle of the egos we could be passing on something useful.

So here we all are, hanging by the edge of our seats, waiting for definitive proof that HCQ does not help in fighting COVID-19 and we keep getting these half-assed reports, seemingly more aimed at pushing a narrative than to present (or eliminate) an option in a fight.

One of the latest examples is the account of Rita Wilson (wife of Tom Hanks) who survived what seems like a difficult case of COVID-19 and shared her experience with the media: she felt very tired, extremely achy, uncomfortable, didn't want to be touched, on the ninth day her fever climbed up to 102 and she had chills like she'd "never had before" (her words), she lost her sense of taste and smell. Then she was given chloroquine, her fever broke (it's not clear how long after). She goes on to warn against the "extreme" (her word) side-effects she attributes to chloroquine: she was completely nauseous, she had vertigo, she could not walk and her muscles felt very weak. She then concludes that although her fever broke after been given chloroquine, she doesn't know if it helped or if it was just time, which is fair. What do you imagine the headline for that story should be? Well, to save you the trouble, most read like this Rita Wilson warns against "extreme" side-effects of chloroquine.

Are HCQ/CQ effective? We're still sitting here like idiots not knowing. If they are, should they be taken carelessly? Definitely not, we already got that, thanks, but that is not the point. We can't afford to have an "all or nothing" mindset with these drugs as we did with masks. Simply proclaiming that HCQ is useless because it is shown not to reduce viral load is just the best way to pass on some other ways it might be helping. If it is shown to have other palliative effects that actually help patients in their fight, such as reducing inflammation or helping cope with high fever long enough for your immune system to do the job, it's not nothing. It's information. It's an option.

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