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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

#61

Post by majormajor »

apendleton wrote: post #15

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…

> 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?

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

#62

Post by jeffdavis »

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".

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

#63

Post by johntb86 »

koheripbal wrote: post #34
apendleton wrote: post #15

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…

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.

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

#64

Post by code_duck »

the_af wrote: post #46
war1025 wrote: post #43

Earlier quoted context omitted.

> Lots of conflicting research happening That's my main take-away at this point. I have seen enough reports saying it worked, and enough saying it didn't that I believe the answer is probably somewhere in the middle. My understanding is the best guess for how it works is by keeping the viral infection from becoming serious enough to require hospitalization. Similar to how proper treatment of wounds early on keeps the…

I'm out of the loop here: why would any political faction not want an alleged cure to work? What's the goal here?

It’s somewhat more complex: one political faction claims that the other wants more people to die so that side can have a political victory. Supposedly, one side wants ‘the cure’ not to work, which means the other side can play victims. Nothing new, it’s just like claiming that liberals want to sell out to communists or Satan or whatever.

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

#65

Post by phkahler »

the_af wrote: post #46
war1025 wrote: post #43

Earlier quoted context omitted.

> Lots of conflicting research happening That's my main take-away at this point. I have seen enough reports saying it worked, and enough saying it didn't that I believe the answer is probably somewhere in the middle. My understanding is the best guess for how it works is by keeping the viral infection from becoming serious enough to require hospitalization. Similar to how proper treatment of wounds early on keeps the…

I'm out of the loop here: why would any political faction not want an alleged cure to work? What's the goal here?

President Trump encouraged trying hydroxycloroquine early on when there were early indications it might work. The problem is that he is considered such a villain by the left that they want it not to work just to prove him wrong. Such is the state of politics in the US.

IMHO he was right to lean on the FDA to find out if its effective. Since it's already available, it would make sense for doctors to try it, but most are not trained in doing controlled trials so the results are all over the map.

Most noticable to me is that when referring to this issue/drug, the media always points out that HCQ is not approved for covid-19. They neglect to point out that there is no approved treatment at all. It seems like an attempt to make Trump look reckless and irresponsible.

Objectivity and politics dont mix.

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

#66

Post by egl2020 »

majormajor wrote: post #61
apendleton wrote: post #15

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…

> 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?

You might have accumulated too much damage or other failure modes might have kicked in.

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

#67

Post by mfer »

It's important to note that this study did not evaluate or note that Hydroxychloroquine had no effect on all people in all situations with COVID-19.

This was a targeted study looking at a specific circumstance. The situation was "all adults in 4 French hospitals with documented SARS-CoV-2 pneumonia and requiring oxygen ≥ 2 L/min"

So, adults who were not on oxygen are not included in the study. How does it pertain to them? That's not covered by this.

It reads like it's saying people who are in bad shape and on ventilators did not have a positive impact by Hydroxychloroquine.

This still leaves open questions like, can the use of Hydroxychloroquine lower the rate of needing to get on a ventilator.

I look forward to someone reproducing this study and looking into the other areas.

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

#68

Post by jbeam »

winstonewert wrote: post #51
the_af wrote: post #46

Earlier quoted context omitted.

I'm out of the loop here: why would any political faction not want an alleged cure to work? What's the goal here?

Trump said positive things about it. The left wants Trump to be wrong about everything, so wants this it to fail. The right wants Trump to be right about everything, so wants it to work.

I think it’d be far more accurate to say that the left wants Trump to stop spreading misinformation on the topic than to say the left is so Machiavellian that it isn’t interested in a cure. For the most part the left seems very happy to just amplify anything Fauci says.

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

#69

Post by blakesterz »

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%…

Would it be the same thing to do 1,000 small studies like this one as doing one LARGE study with 1000x more people? Would the results be considered just as useful?

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

#70

Post by agumonkey »

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 hanging troll [1] or if he's just so far above the pack that everybody else is braining wrong. That's also his motto... he likes to discuss disruption and paradigm shift in his classes and talks about how every past paradigm was considered gold standard and only people breaking the mold advanced the state of the art.

[0] unsurprisingly Musk is also very fond of wide stats to justify his AutoPilot ~feature

[1] his lab specializes in repurposing well studied compounds for new diseases.. seems like leveraging past efforts to get success (if I go full paranoia :)

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