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France, Italy, Belgium stop hydroxychloroquine use for Covid-19 on safety fears

reuters.com

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Re: France, Italy, Belgium stop hydroxychloroquine use for Covid-19 on safety fears

#31

Post by sp332 »

lbeltrame wrote: post #17
mxcrossb wrote: post #15

Earlier quoted context omitted.

It seems like we’re in trouble if we try to pursue a drug that has to be administered early in the disease process. Such a large percentage of people recover on their own that even a very effective drug has limited returns. And of course you need the infrastructure to detect the disease early and deliver huge supplies. It makes me worry that all antivirals we try will fail.

> It seems like we’re in trouble if we try to pursue a drug that has to be administered early in the disease process. This is the same for remedisivir, and also for ritonavir/lopinavir/ribavirin: they must be given within 7 days of symptom onset to be effective. In fact, the latter was deemed unsuccesful in a first paper, because it was given late, then it was reconsidered when given earlier during the disease. This…

https://arstechnica.com/science/2020/05/the-antiviral-remdes...

participants who entered the trial more than 10 days after the onset of symptoms actually showed a better response to remdesivir than those who started being treated during the first 10 days of being symptomatic.

It's not a huge improvement, but it doesn't seem to be too dependent on starting treatment early.

Re: France, Italy, Belgium stop hydroxychloroquine use for Covid-19 on safety fears

#32

Post by core-questions »

mariodiana wrote: post #16
cm2187 wrote: post #11

Earlier quoted context omitted.

Particularly in the case of a 1950s drug that has been consumed by millions of people, and which as far as I know was available without prescription until covid. It’s like saying aspirin is dangerous. Sure. At a certain dosage.

Exactly. And the dosage being given for COVID-19 patients is comparable to the dosage given for patients with chronic conditions such as lupus, only the COVID-19 patients are given the drug for something like a week, while the chronic patients are given the drug indefinitely. Meanwhile, drugs like benzodiazepines are basically just dumped on a largely unwitting populace with the tacit blessing of these very same peop…

Shh, don't mention the opiate / benzo crisis. We know this disproportionately affects Middle America, and therefore is not something we can bring up as a serious topic of conversation.

Re: France, Italy, Belgium stop hydroxychloroquine use for Covid-19 on safety fears

#33

Post by cm2187 »

acallaghan wrote: post #20
lbeltrame wrote: post #2

A shame, since the Lancet paper has problems[1][2] in particular related to the baseline of the HCQ-treated vs non-HCQ treated patients. And by admission of the authors themselves, it is not a substitute of a RCT. And this before the results of the Minnesota trial are out. At this point I hope those are negative, so that it does not show that countries are overreacting. [1] https://statmodeling.stat.columbia.edu/2020…

If it had any effect on covid-19, it'd be very obvious by now. There isn't some massive conspiracy here, it just doesn't work. The reason trials have stopped is because France, Italy, Belgium & the UK have seen worse outcomes generally, directly because of it. I don't get the 'it needs to be taken before symptoms!' argument - like we can possibly give a immunosuppressant with non-negligible side-effects (e.g. arrythm…

The first symptoms aren't necessarily the shortness of breath. In my case I had a week of mild fever before the shortness of breath kicked in. Fever isn't severe. Difficulty to breath is. You can have a policy to be treated when you get the first symptoms, but before these symptoms are severe.

Re: France, Italy, Belgium stop hydroxychloroquine use for Covid-19 on safety fears

#34

Post by jacques_chester »

lbeltrame wrote: post #24
acallaghan wrote: post #20

Earlier quoted context omitted.

If it had any effect on covid-19, it'd be very obvious by now. There isn't some massive conspiracy here, it just doesn't work. The reason trials have stopped is because France, Italy, Belgium & the UK have seen worse outcomes generally, directly because of it. I don't get the 'it needs to be taken before symptoms!' argument - like we can possibly give a immunosuppressant with non-negligible side-effects (e.g. arrythm…

Not before symptoms, but after exposure, or early on during the course of the disease, like other antivirals. I reinstate, before people think I'm some sort of HCQ defender: I am not. The effect size is probably very small. It may be as well that it doesn't work, and I would be happy even if it doesn't. I just want to see a proper RCT done and sealed.

You're not unique in wanting an RCT, but the decisions can't wait.

On currently-available evidence, the balance of risks is to not prescribe this drug for treatment of C19.

Re: France, Italy, Belgium stop hydroxychloroquine use for Covid-19 on safety fears

#35

Post by ytNumbers »

ceejayoz wrote: post #28
lbeltrame wrote: post #17

Earlier quoted context omitted.

> It seems like we’re in trouble if we try to pursue a drug that has to be administered early in the disease process. This is the same for remedisivir, and also for ritonavir/lopinavir/ribavirin: they must be given within 7 days of symptom onset to be effective. In fact, the latter was deemed unsuccesful in a first paper, because it was given late, then it was reconsidered when given earlier during the disease. This…

Remdesivir doesn't have the sudden cardiac death side effect, though, does it? HCQ's issue may be a bad combination of "has to be taken early" and "has significant side effects".

HCQ has been around for 70 years. Remdesivir's issue is that everyone gets to be the guinea pig. Sometimes it's better to go with the devil you know.

Re: France, Italy, Belgium stop hydroxychloroquine use for Covid-19 on safety fears

#36

Post by dougmwne »

lbeltrame wrote: post #10
pjc50 wrote: post #6

This is essentially the Andrew Wakefield fiasco on speedrun, isn't it? My skepticism was founded entirely on seeing who was promoting this idea, and it is slowly being vindicated.

> My skepticism was founded entirely on seeing who was promoting this idea The proponent has no effect on the null hypothesis. What was needed was a RCT: no results are out for any, at this point.

I disagree from a statistical point of view. Of all possible hypothesis we choose to study, for the great majority we will fail to reject the null hypothesis. (For most things we study, we will find the treatment has no discernible effect.)

If some unstudied hypothesis is being promoted at random by vested interests, the chance that it is in fact an effective treatment is low because most treatments we would try are ineffective. And a vested interest will use every rhetorical tool at its disposal to promote what it is selling, including citing studies and scientists. If those do not exist or seem low-quality then skepticism is warranted. We should be wary of all medical claims till they are supported by high quality evidence.

Re: France, Italy, Belgium stop hydroxychloroquine use for Covid-19 on safety fears

#39

Post by take_a_breath »

lbeltrame wrote: post #10
pjc50 wrote: post #6

This is essentially the Andrew Wakefield fiasco on speedrun, isn't it? My skepticism was founded entirely on seeing who was promoting this idea, and it is slowly being vindicated.

> My skepticism was founded entirely on seeing who was promoting this idea The proponent has no effect on the null hypothesis. What was needed was a RCT: no results are out for any, at this point.

If the snake oil salesman presents a new, improved brand of snake oil, skepticism is wise.
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