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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

#121

Post by CydeWeys »

Symmetry wrote: post #98
CydeWeys wrote: post #22

Earlier quoted context omitted.

That may be, but it's gonna be harder logistically to do a study commencing from onset of symptoms vs at moment of hospitalization. There's also the fact that study makes it less likely that pre-hospitalization HCQ will have any effect either. Applying a Bayesian analysis here, it's now likelier that the true ground truth is simply that HCQ doesn't do anything to COVID-19 at all, not necessarily that it works only in…

The study that made me think there might be something to it was looking at people taking it for unrelated illnesses and finding that they weren't tending to show up hospitalized with Covid-19. I'd agree that we really don't have any evidence that giving it to hospitalized patients helps at all. Most antivirals have to be taken at the early stages of an infection. The best looking treatment for people seriously ill wi…

Good to know, I'll keep my eyes out on those studies as well.

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

#122

Post by subsubzero »

frgtpsswrdlame wrote: post #37
koheripbal wrote: post #34

Earlier quoted context omitted.

Yeah, the devil is really in the details about exactly when and how you administer it. Doctors are already saying that it's definitely no magic bullet, but they debate whether it is effective at a certain stage of illness. What I don't understand is why we're focusing so much on this specific drug when there are some great antivirals out thee that have a more effective theoretical mechanism of action. (eg Remdesivir)

Because this drug can be cheaply manufactured out of patent. Let's say Remdesivir is the only drug that works, it's basically an admission that Gilead is going to have us over a barrel.

> it's basically an admission that Gilead is going to have us over a barrel

That's absolutely not what would happen. I was chatting with a family member who used to work in biotech/pharma and posed the question what would happen if Remdesivir is found to have efficacy against covid-19. What they said is basically there would be licensing done immediately to other pharma companies which would run manufacturing in parallel with what Gilead is doing. Gilead will be getting profits from each pharma company that gets a license. I am unsure why the lead time is so long, however it may be that the company does not want to create a huge supply of a drug that may not be effective. But this is very interesting, the pentagon is getting lots of remdesivir for troops so there must be some info that leadership has about its success rate: https://qz.com/1834939/how-the-military-secured-experimental...

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

#124

Post by smacktoward »

johntb86 wrote: post #63
koheripbal wrote: post #34

Earlier quoted context omitted.

Yeah, the devil is really in the details about exactly when and how you administer it. Doctors are already saying that it's definitely no magic bullet, but they debate whether it is effective at a certain stage of illness. What I don't understand is why we're focusing so much on this specific drug when there are some great antivirals out thee that have a more effective theoretical mechanism of action. (eg Remdesivir)

Remdesivir could be great, and there are a lot of studies ongoing about it. However, it has a long production time - Gilead says 6 to 8 months: see https://www.gilead.com/purpose/advancing-global-health/covid... . They're only projecting to have 500,000 treatment courses by October, so it could only help a relatively small fraction of the people that will have coronavirus.

Even a small volume of an effective treatment could still be helpful. Usage could be restricted just to patients with cases serious enough to otherwise require ventilators, for instance, which would both ease the strain on limited ICU resources and save lots of people who would otherwise die (since only around 10-30% of ventilated patients survive even with that treatment).

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

#126

Post by CydeWeys »

danans wrote: post #118
CydeWeys wrote: post #32

Earlier quoted context omitted.

It's only advised if it actually works. If it doesn't work, then there's still no point in taking it because the side effects are still bad. And there's no good evidence that it even works, and some mild evidence that it doesn't.

Yes, and even if it did work to reduce severity of the illness (agreed that there is no evidence of this), it seems like for low-risk people, the risks of heart damage outweigh the benefits of taking it. After all, what's an extra week or two of illness vs a 7-28% chance of heart damage.

Yup. I'm in a relatively low risk factor group and got over COVID-19 at home, no hospitalization necessary and nothing stronger than acetaminophan needed. I don't think a decent change of permanent heart damage was what I needed through all this. Also, I would have had a higher chance of being hospitalized from the side effects of the HCQ than from the COVID-19, which is really not what the hospitals need right now.

The HCQ doesn't seem remotely merited based on its potential side effects unless you are in a higher risk factor for the disease, and of course even then, it's only merited it's actually efficacious (which it's seeming so far it isn't).

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

#127

Post by twomoretime »

It really bothers me how hard both citizens and officials seem to be wanting Chloroquine to fail all because somebody they didn't like endorsed it publicly. Can't let him have that win, right? Like children.

The original studies that showed promise used combinations of Chloroquine, Azithromycin, and or zinc, and there is a speculated pathway by which these drugs interact to interfere with COVID replication. This study only looked at HCQ.

This kind of partisan, childlike pettiness is dangerous to all of us - what if Chloroquine works but we overlooked it because a couple shitty papers told us what we wanted to hear?

Was it appropriate to tweet about? Debatable. It is a presidents job to keep his people hopeful when possible, and this drug cocktail was in multiple (admittedly not perfect) papers at the time of the tweet. People need to be more objective when evaluating statements made by the president. That doesn't mean you have to like him.

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

#128

Post by Robotbeat »

asdfasgasdgasdg wrote: post #102
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%…

> "no evidence of efficacy" does not imply evidence of no efficacy 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...

It’s not if the statistics are too small. It’s only evidence against a strong effect (which the parent acknowledges).

I think the parent post is making an important and accurate point.

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

#129

Post by mcguire »

pcj-github wrote: post #76

Aside from these results, what is the proposed mechanism of benefit here? And why are we expecting a mechanism with hydroxychloroquine against this virus when essentially no small molecule therapies are effective against viruses in general?

Hydroxychloroquine is an immune suppressant and may help reduce the cytokine storm effect. How that interacts with the "you have to start it early" issue is unclear to me.

And it might keep you from getting malaria while you have COVID19.

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

#130

Post by smacktoward »

tomohawk wrote: post #94
munk-a wrote: post #52

Earlier quoted context omitted.

Only if we chose to let them bend us over said barrel? The US government could simply seize the patent if Gilead acted in a manner against the public good.

And then what happens next time? Why spend all the time and effort, only to have what you did nationalized? Incentivizing people to not do productive things like develop drugs seems like a really bad idea.

Nobody’s saying Gilead can’t make a profit. Just that they can’t make an obscene (“have us over a barrel”) profit.
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