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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

#291

Post by kerkeslager »

gameswithgo wrote: post #144
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%…

It is important to remember we also do not have evidence of no efficacy for chocolate milk. Yet we do not waste our time testing it.

Okay but there are actually good reasons to test hydroxychloroquine, as it is effective against viruses with relevant similarities to Covid-19. The same is not true for chocolate milk.

To address the elephant in the room: yes, Trump did come out in favor of hydroxychloroquine, but his opinion on medical issues is literally meaningless noise in both the informational and auditory senses of the phrase. We certainly shouldn't be pursuing hydroxychloroquine because Trump said to, but there are other good reasons to at least investigate it.

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

#292

Post by bcrosby95 »

dang wrote: post #255
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.

(This subthread was originally a reply to https://news.ycombinator.com/item?id=22880291 )

You may as well delete it. My point was to caution against the continued enthusiam of using this drug for COVID-19 despite the consequences of doing so.

The original article has no such problem. Yet the person I replied to could be interpreted as "wait, maybe its still good!". My comment makes zero sense as a reply to the original article.

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

#293

Post by DoreenMichele »

downerending wrote: post #290
DoreenMichele wrote: post #286

Earlier quoted context omitted.

I generally try hard to stay out of politics and to intentionally not get caught up in the Trump bashing that is quite common in my Twitter feed. I'm having a really hard time trying to abide by that rule in this case. I will suggest that you may have cause and effect backwards in at least some cases. Some people may be bitterly opposed to him because of nonsense like this rather than thinking this is nonsense becaus…

No doubt it's some of each. Difficult to imagine anyone having a strong opinion on some random drug if he wasn't involved, though.

He's the president of the US (aka the most powerful political leader in the world). Whatever one's personal feelings about the man, him touting something unproven while in such a powerful role is bound to get a rise out of people.

He has an obligation to look out for his people. This is not how you do that. This is the opposite of responsible behavior.

I'm quite upset about the whole thing, not because I'm anti Trump, but because it's a global pandemic. This isn't run of the mill, business as usual bullshit where political things like cronyism and glad handing make any sense whatsoever.

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

#294

Post by firasd »

DoreenMichele wrote: post #219

This study is specifically about patients sick enough to be put on oxygen. The top ranked comments don't seem to address that detail. Some thoughts: My understanding is this is a powerful alkaloid. My experience has been that similar compounds can help combat inflammation. They also can work to help kill infection at times. By the time people with Covid19 need oxygen, inflammation doesn't seem to be the primary probl…

You might find this thread interesting (“There's a growing body of data to strongly suggest #COVID19 predisposes to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilization and diffuse intravascular coagulation.”)

https://twitter.com/scottgottliebmd/status/12500696095810314...

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

#295

Post by vonmoltke »

3fe9a03ccd14ca5 wrote: post #280
adrr wrote: post #241

Earlier quoted context omitted.

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.

So far, the results are not looking good: https://sciencebasedmedicine.org/miracle-cure-testimonials-a...

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

#296

Post by fspeech »

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%…

There are two potential benefits of hcq people are hoping to prove: first as an antiviral, secondly as an immuno modulator for the IL-6 pathway. As a nonspecific antiviral any benefit tends to be for the early stage of the disease, possibly as a prophylaxis or preventive. So to me this trial mostly shows that there is no discernible benefit for hcq as an immuno-modulator. That is disappointing but not too surprising. I hear people with autoimmune problems say that it takes a month or two for the drug's effect to kick in. That is about 12g of cumulative dose, too big to reach in a short time without acute toxicity. I wonder here if also people of the high risk group could benefit from prophylactic use. Is there any truth to the claim that lupus patients on hcq don't suffer from covid? This claim should be easy to check now that we have so many cases of covid around the world.

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

#297

Post by koheripbal »

rsynnott wrote: post #220
SlowRobotAhead wrote: post #145

Earlier quoted context omitted.

As insane as that is. And how funny is it (at least to me) that this is only because Trump came down on one side initially. If he had come out saying exactly the opposite, that HCQ was bad and we should be skeptical, everyone hoping it doesn’t work now would be looking for the 10 person studies saying it totally works and defending its use. It’s almost beyond reason how hyper partisan this specific issue is.

This isn't left vs right; it's an unqualified politician vs pretty much all of the scientific community.

This is not accurate and kind of exposes your own bias.

If you listen to virologist podcast, TWIV, they talk about the effectiveness of HCQ. They aren't all "it's amazing!", but they do not make the claim that it doesn't work.

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

#298

Post by downerending »

DoreenMichele wrote: post #293
downerending wrote: post #290

Earlier quoted context omitted.

No doubt it's some of each. Difficult to imagine anyone having a strong opinion on some random drug if he wasn't involved, though.

He's the president of the US (aka the most powerful political leader in the world). Whatever one's personal feelings about the man, him touting something unproven while in such a powerful role is bound to get a rise out of people. He has an obligation to look out for his people. This is not how you do that. This is the opposite of responsible behavior. I'm quite upset about the whole thing, not because I'm anti Trump…

Yeah, I think we're all pretty unnerved. And we're far from knowing just how deep this rabbit hole is going to be. (Or how shallow.)

If you look at the charts of per-capita deaths in various countries, there's not much of a pattern, in terms of places we'd think of as having "good" government and/or public health versus "bad". Belgium, for example, is the worst right now (or among them), and many European countries are doing quite badly.

My personal suspicion is that in a case like this, there isn't really that much difference in in-the-moment governing across countries.

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

#299

Post by jamesblonde »

URSpider94 wrote: post #272
radford-neal wrote: post #240

Earlier quoted context omitted.

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,…

My immediate reaction was that I would not expect to see an effect if you are giving HCQ to patients after they have been hospitalized by the virus. You are now into the inflamation/cytokine storm phase of COVID-19. The best chance of HCQ working is very early, ideally before or directly after exposure. The jury is still out if you take HCQ after the onset of sympthoms if that is also too late. Based on this in-vitro study - https://www.nature.com/articles/s41421-020-0156-0 - if I hypothetically had both Chloroquine (CQ) and Hydroxychloroquine (HCQ), I would prefer HCQ for prophylaxis/pre-sympthoms, but if I was sympthomatic, I would choose CQ. The loading time or HCQ is longer and it appears less effective at higher MOIs "the data suggest that the anti-SARS-CoV-2 activity of HCQ seems to be less potent compared to CQ, at least at certain MOIs."

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

#300

Post by jamesblonde »

fspeech wrote: post #296
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%…

There are two potential benefits of hcq people are hoping to prove: first as an antiviral, secondly as an immuno modulator for the IL-6 pathway. As a nonspecific antiviral any benefit tends to be for the early stage of the disease, possibly as a prophylaxis or preventive. So to me this trial mostly shows that there is no discernible benefit for hcq as an immuno-modulator. That is disappointing but not too surprising.…

Excellent point - this study does add to our knowledge - the case is now pretty much closed on the efficacy of HCQ as an immuno modulator for COVID-19.
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