101–110 of 379 posts
Given that I need hydroxychloroquine to treat my rheumatoid arthritis, I'd like this hypothesis to be either proven or disproven as rapidly and as unambiguously as possible.
You want it disproven, otherwise you won't be able to get your hands on hydroxychloroquine.
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%…
That's incorrect. Absence of evidence is evidence of absence. It's just not proof of absence. See https://www.lesswrong.com/posts/mnS2WYLCGJP2kQkRn/absence-of...
Point is that the study is done at the wrong stage, too late.
You may be right, but isn't acting like we all knew this is moving the goalpost?
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
Earlier quoted context omitted.
The rest of the statistics: " In the weighted analysis, 20.2% patients in the HCQ group were transferred to the ICU or died within 7 days vs 22.1% in the no-HCQ group (16 vs 21 events, relative risk [RR] 0.91, 95% CI 0.47-1.80). " And... " Eight patients receiving HCQ (9.5%) experienced electrocardiogram modifications requiring HCQ discontinuation. "
Question: are the induced arrhythmias permanent or do they discontinue when HCQ therapy discontinues? I'm curious as to the permanency of the damage.
Earlier quoted context omitted.
Politically, yes, there was/is a cargo cult. Both for those convinced it's a cure, and the anti-cargo-cult opposing party convinced it's somewhere between useless and actively harmful. From a medical practice standpoint, you have a widely-available drug with well-known side effects that can be administered in a medical setting with low risk, and potential life-saving upside. When the research is early but potentially…
The problem with 'low risk / high upside' is that it can apply to anything. We can try lemonade since it has low risk and high upside. But at some point we have to start wondering if we should all be obsessed with lemonade right? Even when doctors were using HCQ before the politicians and random outsiders picked up on it, there were other drugs in the mix that they were also considering (Lopinavir, Remdesivir, etc).…
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…
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%…
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"
Earlier quoted context omitted.
The rest of the statistics: " In the weighted analysis, 20.2% patients in the HCQ group were transferred to the ICU or died within 7 days vs 22.1% in the no-HCQ group (16 vs 21 events, relative risk [RR] 0.91, 95% CI 0.47-1.80). " And... " Eight patients receiving HCQ (9.5%) experienced electrocardiogram modifications requiring HCQ discontinuation. "
Wouldn’t ecg changes be plausibly the result of the virus itself? I haven’t read the paper so maybe they go into greater detail but it would be important to know whether such changes were seen in the control group as attrition/discontinuance is critically important to any study.
Those ECG changes aren't generally observed just in people who have COVID-19; it's the drug that we know does that, doing that.