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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

#271

Post by perl4ever »

beaner wrote: post #214
eesmith wrote: post #176

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.

This is perhaps anecdotal, but one of the articles I saw, said that a person who was denied their medication was specifically told it was because it was being reserved for COVID-19 victims.

So while you could doubt such a story for other reasons, the causal linkage is being made explicitly in at least some instances.

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

#272

Post by URSpider94 »

radford-neal wrote: post #240
URSpider94 wrote: post #195

Earlier quoted context omitted.

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…

I have no problems with the way this test was set up. It was a quick study that would have told us quickly if there was a huge benefit from HCQ. That wasn't the outcome. Larger tests with better statistical power will tell us if there is a smaller positive effect. My point is, the smaller the beneficial effect, the larger the test will have to be to find it, but also the lower the overall benefit to patients.

Again, note also that more patients on HCQ were diagnosed with ARDS, so if you pick a different measure, you get the opposite result.

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

#273

Post by beaner »

eesmith wrote: post #246
beaner wrote: post #214

Earlier quoted context omitted.

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 answe…

I think characterizing my questions as absurd is itself revealing of a bias. There is no judgment in my questions, I'm just trying to get at the answers.

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

#274

Post by URSpider94 »

taborj wrote: post #196
URSpider94 wrote: post #180

Earlier quoted context omitted.

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…

> 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. In general, that doesn't mean we should simply abandon all attempts to de-politicize it. In fact, it means just the opposite - we should put aside any political aspects and focus on objective data.

Agreed, of course. The difficulty is when one side of the argument is saying "take this medicine, it will help you," and the other side is saying "no, we don't know that yet." So, effectively, one side of the argument is arguing not to politicize the issue, the other side is doubling down on focusing on anecdotal data.

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

#275

Post by rq1 »

chasd00 wrote: post #238
thepangolino wrote: post #179

Earlier quoted context omitted.

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...

No grain of salt needed, the chloroquine is a zinc ionophore.

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

#276

Post by KarlKemp »

bluGill wrote: post #95
tobessebot wrote: post #77

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.

It’s almost funny that the best that Trump supporters can come up with these days is “but everyone knows he has no clue and lies a lot”.

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

#277

Post by nkozyra »

twomoretime wrote: post #158
nkozyra wrote: post #143

Earlier quoted context omitted.

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 m…

> https://youtu.be/oWQjWepaDv0 "Very promising early results". > https://www.google.com/search?q=trump+tweet+chloroquine&prmd... "Have a real chance to be one of the biggest game changers" Meanwhile the media response has been universally lamenting that a president would "tell people" [he didn't] to take this drug. How many outlets jumped on the single chloroquine phosphate overdose as proof of the president's respon…

I think this vastly underestimates the power of someone in that position.

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

#278

Post by perl4ever »

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 not like this is coming from the National Enquirer"

It could be! I mean, his ideas presumably don't come from taking a random issue of the National Enquirer at face value, but he has or had a widely reported close relationship with the publisher, so it seems entirely plausible he might have been influenced by, say, David Pecker's opinions.

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

#279

Post by 3fe9a03ccd14ca5 »

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…

Completion date: April 1st 2021. Too little too late for much of the country.

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

#280

Post by 3fe9a03ccd14ca5 »

adrr wrote: post #241
StevePerkins wrote: post #198

Earlier quoted context omitted.

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…

The difference of course is that HCQ is part of the existing treatment plan of SK, France, and other countries. At the very least we’ll have a large sample size in the next few months.
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