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Study: No evidence of efficacy of hydroxychloroquine in hospitalized patients

medrxiv.org

321–330 of 379 posts

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

#321

This whole debate is insane to me -- some people that so-called "experts" don't like mentioned HCQ as a possible treatment for coronavirus, and we've ended up in some bizarro world where everyone is shouting and fingers are being pointed over something that really shouldn't be controversial or perceived as some sinister plot to destroy clever society. 1. HCQ has been used for many decades 2. The side effects are gene…

> ...this should certainly be tried as a treatment...

What? Why not try literally anything and everything else that has not been proven?

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

#322
I know this study doesn’t put anything to bed, but one has to understand that the basis for the HCQ and CQ (+/- zinc) thing is the same as x kills cancer in vitro. Then, you get a motivated researcher who publishes a single arm study of essentially OK patients claiming zero deaths. Game changer? We’ll see. But I imagine there are hospitals that are already using this as a first line treatment and there’s no positive reviews from the front line.

Beyond that, we do have the ability to perform small sample studies (cf. Student) and decide whether we’re headed in the right direction. Are we in a lull in statistics where we can’t even use statistics to guide future research?

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

#323

Earlier quoted context omitted.

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 a…

Sadly, people who get it right are frequently remembered as "lucky" after the fact or even sometimes get maligned in some manner.

When I took archery in college, I was the only one in class who could consistently hit the bullseye. I also practiced up to two hours a day.

A classmate who didn't practice, who had terrible form and was holding the bow all wrong and who couldn't manage to hit the target at all snidely informed me one day that it was all luck. He completely dismissed the idea that either proper form or practice made any difference whatsoever.

I know that in complicated situations, it can be quite hard to determine what actually worked and why. This is why humanity has practices like deferring to experts with a solid track record of success as evidence that they know whereof they speak, even if it basically looks like stuff and nonsense to most of the rest of us because we don't all have a PhD in that subject and a zillion years of experience like them.

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

#324
post #50

Earlier quoted context omitted.

> 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.

I wouldn't expect a given prophylaxis case to take more than ~2 weeks to assess (the recommended quarantine time), and I would expect there to be significantly more eligible participants for that arm than the others. Am I missing something?

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

#325

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"

This is the kind of study where it would be beneficial for it to be ignore. The correct headline is no headline at all.

Well, given the time constraints, and the fact that the previous paper was had a much weaker setup yet claimed efficacy, I think this paper is a good idea. Incidentally, it's not the only such paper; a chinese analysis from the early days came to a comparable conclusion.

Even based just on this evidence, the case for HCQ looks very, very weak. The only positive report was riddled with caveats that could easily explain a false-positive, and other reports see next to no effect.

Note that it's perhaps not so interesting whether it has some effect; for this to really matter, it needs to be somewhat significant effect (in the real-world impact sense, not the statistically measurable sense). And even a small sample can reliably detect large effects; several studies have now not found such an effect; ergo: it doesn't exist.

If HCQ has any benefit whatsoever as applied once very sick, the benefit is likely too small to matter much in terms of mortality. And it's unlikely to be relevant whether it works beforehand; there's no way to make enough to give it to everyone which is what you'd need to do if you wanted to significantly impact the pandemic if HCQ were prophylactic.

It seems very unlikely at this point that HCQ is going to matter much in the course of the pandemic.

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

#326

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 po…

The preprint you linked (https://www.medrxiv.org/content/10.1101/2020.04.08.20054551v...) is a huge analysis based on historical health records (> 300k per condition).

> Worryingly, significant risks are identified for combination users of HCQ+AZM even in the short-term as proposed for COVID19 management, with a 15-20% increased risk of angina/chest pain and heart failure, and a two-fold risk of cardiovascular mortality in the first month of treatment.

Based on that, azithromycin would appear to be a decidedly bad choice of antibiotic to use in conjunction with HCQ. Luckily there are many others available.

Derek Lowe has a recent and much more detailed analysis of all of this. (https://blogs.sciencemag.org/pipeline/archives/2020/04/11/th...)

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

#327

Given the study's small sample size, it seems the only way it would have produced a conclusive result is if the effect size was huge (i.e. miracle cure). The study found some evidence of efficacy, but it was not significant given the sample size. A better headline would say something like: "study finds that HCQ is not a miracle cure for already-hospitalized covid-19 patients".

What effect size would be a “game changer”?

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

#328

Earlier quoted context omitted.

You want it disproven, otherwise you won't be able to get your hands on hydroxychloroquine.

That's kind of a ghoulish sentiment to attribute to someone else.

I don't believe that the sentence pattern which I used attributes sentiments to others.

"You want ..." functions as as rhetorical idiom.

"You want X or else Y" roughly means "Unless X, Y, thus you will be objectively disadvantaged".

The sentiment, if there is one, remains mine; on the other hand, this "ghoulish" is in fact an external interpretation of sentiment being ascribed to me.

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

#329

Earlier quoted context omitted.

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…

I didn't claim that the QT prolongation implied arrhythmia.
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