Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

medrxiv.org

Post reply on HN
Print view View original

301–310 of 379 posts

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

#301

Post by jamesblonde »

epmaybe wrote: post #106
shadowgovt wrote: post #97

Earlier quoted context omitted.

Question: are the induced arrhythmias permanent or do they discontinue when HCQ therapy discontinues? I'm curious as to the permanency of the damage.

the qt prolongation of heart rhythm goes away once discontinued.

Qt prolongation does not mean you have arrhythmias. You don't get tachycardia or atrial flutter or necessarily sympthoms. Clinically if it means there is a risk if the QT interval gets to long that you will have a fatal arrhythmia - torsades de pointes. So you need to know how bad the Qt prolongation is. In the paper 2 patients had serious side effects - one with QT prolongation over 500ms and the second with a first-degree atrioventricular block. Another maybe had a left bundle branch (not great, but not fatal). They resolved by stopping HCQ treatment.

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

#303

Post by randcraw »

roywiggins wrote: post #226
gvjddbnvdrbv wrote: post #174

Earlier quoted context omitted.

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.

To offer some perspective, in Montgomery County, just north of Philly (a suburban metro county harder hit than most), 10% of positive tests have been admitted to hospital, and 2.6% of positive tests have gone on ventilators.

So the subpopulation needing remdesivir is probably less than 5% of the positive cases (or 1250 of the 25,000 who tested positive here). BTW, the county population is 900,000.

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

#304

Post by jdkee »

anoncareer0212 wrote: post #73
majormajor wrote: post #61

Earlier quoted context omitted.

> 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?

Hydroxycholorquine is an immunosuppresant not an anti-viral, so the theory here is the problem isn't the virus, but reacting to it. It's not quite as silly as it sounds - this does, rarely, work, specifically with malaria. But, it is pretty silly when you contrast the likelihood of it being a meaningful thereapeutic versus the significance it's taken on

This is the popular origin of the hydroxycloroquine and zinc thesis.

https://www.youtube.com/watch?v=U7F1cnWup9M&list=PLQ_IRFkDIn...

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

#305

Post by tptacek »

jamesblonde wrote: post #299
URSpider94 wrote: post #272

Earlier quoted context omitted.

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…

For pre-symptomatic C19 patients, we're already doing a large-scale natural experiment, because HCQ is part of widespread protocols for common ailments like RA, and the dosages those patients get are comparable. As I understand it: we're admitting lots of RA patients with C19; there doesn't seem to be a huge effect with early dosages either?

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

#306

Post by Gibbon1 »

tptacek wrote: post #305
jamesblonde wrote: post #299

Earlier quoted context omitted.

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…

For pre-symptomatic C19 patients, we're already doing a large-scale natural experiment, because HCQ is part of widespread protocols for common ailments like RA, and the dosages those patients get are comparable. As I understand it: we're admitting lots of RA patients with C19; there doesn't seem to be a huge effect with early dosages either?

Problem with that is people with RA and Lupus are typically hyper careful about their health and most likely to be serious about self isolating.

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

#307

Post by _Wintermute »

agumonkey wrote: post #70
firasd wrote: post #41

When the Covid crisis is over, one of the strangest sub- plots will have been the fracas around Hydroxychloroquine. Starting from medical practitioners worldwide adopting its usage in a ‘cargo cult’ way, mimicking what other doctors were doing, to Raoult’s low- quality study. Then people in Silicon Valley (notably Elon Musk) picking up the idea. Followed by the explosion in the political sphere, from Trump pushing it…

The recent reports about low benefits of HCQ didn't stop Raoult from appearing in a video about the state of HCQ and covid-19 in his clinic. Sadly he seems to be yet again using very wide statistics to justify his views (covid is of no importance compared to yearly stats [0]) and digress into political attacks (his past interactions with pharma labs that weren't conflict of interests). I still can't say if he's a low…

Even pre-covid, Raoult had a reputation for pumping out hundreds of really poor quality studies and making controversial public claims. It's a shame he's the one that's caught the attention of the general public, there's lots of good work going on with other potential treatments, but suddenly my social media is filled with armchair pharmacologists arguing about this one drug.

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

#308

Post by DoreenMichele »

firasd wrote: post #294
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...

Thank you. It is interesting stuff and fits with some of my impression that they are overlooking important blood-related issues. Anemia (a blood disorder) is also a cause of low oxygen. That's not exclusive to lung function.

Glad to see some doctors are working on that angle. (crosses fingers, hopes for better treatments soon)

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

#309

Post by robbiep »

giardini wrote: post #287
atourgates wrote: post #236

Earlier quoted context omitted.

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 po…

Other antibiotics than azithromycin have been used, e.g., doxycycline. The antibiotic's purpose is to halt opportunistic bacterial infection; many antibiotics are available to do that.

But azithromycin has an ACE2 inhibitory effect and its use in disease modulation is postulated to decrease viral entry to the cell in a similar mechanism to HCQ, hence the discussion of dual therapy there.

The opportunistic bacterial infection is separate (although you’re correct that it has a role here)

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

#310

Post by perl4ever »

jeegsy wrote: post #268
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.

I think the point is that the stated reason for opposition is all rational and proper but the suspicion (based on current year political sentiments) is that it is nevertheless a cover for an altogether irrational hope that the the drug is proven ineffective.

A problem in my view, with attributing a strategy to the opposition, is that without hindsight, when Trump makes a weird/nonsensical/hyperbolic statement like this, you can't know if it's going to vanish without a trace or be doubled down on and become a huge thing.

At the time, who could say if his opinion was based on anything, he would be proven right, anyone would take it seriously, etc.? The public and media don't know these things.

Post reply on HN