First hydroxychloroquine randomized controlled trial: results disappointing • Hacker News Board

Re: First hydroxychloroquine randomized controlled trial: results disappointing

#81

Post by [deleted] » Tue, Mar 24, 2020, 4:29 PM UTC

hannob wrote: post #65

arcticbull wrote: post #35

Earlier quoted context omitted.

In this case (as with many others) placebo is pretty effective, but also, these folks didn't get sick enough to need it, as with the overwhelming majority of young and healthy people. Another, broader study is required. I'm sure we'll find out more soon -- this reads like a mulligan though.

> In this case (as with many others) placebo is pretty effective Where do you get that idea from? In the study it looks like everyone got better, but that may just be regression to the mean (i.e. the normal progression of covid-19 in those patients). If you'd want to know if placebo is effective on covid-19 you'd have to do a completely different study, comparing placebo to doing nothing. Though the likelyhood that p…

[deleted]

Re: First hydroxychloroquine randomized controlled trial: results disappointing

#82

Post by blacksqr » Tue, Mar 24, 2020, 4:32 PM UTC

dev_tty01 wrote: post #71

blacksqr wrote: post #59

Earlier quoted context omitted.

I keep reading this statistic about deaths in Italy, but how much of it is shaped by doctors desperately deciding to withhold care from the sickest in order to save others? i.e., would the age curve be different in an ideal situation where everyone was getting optimal care, and is the statistic thus misleadingly suggesting that younger people are less at risk?

Would the curve be different in an ideal situation where the hospitals weren't completely overrun and out of resources? Yes, of course. However, I would guess that if care was withheld, it was based on disease state and patient robustness. Age is part of that equation so it is hard to separate it out. In other words, a fit healthy, no comorbidity senior whose immune system is fighting hard is probably not having trea…

I was not suggesting that Italian doctors might be withholding treatment "just because of age." Clearly, as you state, there will always be a strong correlation between age and overall health.

I was trying to point out that some people using the statistics about age and mortality from Italy are trying to use them as justification for doing less to combat the disease's spread, and that might be a dangerously misleading gambit.

Re: First hydroxychloroquine randomized controlled trial: results disappointing

#83

Post by bmm6o » Tue, Mar 24, 2020, 4:57 PM UTC

Terretta wrote: post #68

dajohnson89 wrote: post #44

Earlier quoted context omitted.

any data on what percentage of “young healthy” people die/get hospitalized? also, what’s the definition of young and healthy?

Across the United States, 38 percent of those hospitalized were between the ages of 20 and 54. Nationally, 12 percent of the intensive care patients were between the ages of 20 and 44. https://www.nytimes.com/2020/03/23/nyregion/nyc-coronavirus-...

I keep hearing statistics like this and I yell at my TV every time. Counting up the people in the hospital is pretty easy, but it doesn't answer the more important question of how many infected 20-54 require hospitalization. Even comparing those numbers to the larger demographics would be helpful.

Re: First hydroxychloroquine randomized controlled trial: results disappointing

#84

Post by karlshea » Tue, Mar 24, 2020, 4:58 PM UTC

raphlinus wrote: post #72

karlshea wrote: post #26

Earlier quoted context omitted.

Would you mind linking a couple here that are worth a follow?

Even better, I have a very carefully curated list: https://twitter.com/i/lists/1239639611694911489 Every single person on this list is brilliant at what they do and a good communicator, with excellent s/n in their tweets. I've also removed people (like Jeremy Konyndyk, who otherwise I would recommend highly) who have a lot of insight but also a high emotional tone or a tendency to lean into politics. I've also tried…

Thanks!

Re: First hydroxychloroquine randomized controlled trial: results disappointing

#85

Post by cycrutchfield » Tue, Mar 24, 2020, 5:17 PM UTC

xtracto wrote: post #60

cycrutchfield wrote: post #27

Earlier quoted context omitted.

Don't believe everything you watch on youtube.

And what about Peer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182877/ Reviewed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2973827/ Papers? https://www.academia.edu/download/41294025/Zn2_inhibits_coro...

Peer reviewed papers are great, and that’s obviously where medcram got their info from. Whether or not this is the actual mechanism of action for covid-19 has not been demonstrated however.

Re: First hydroxychloroquine randomized controlled trial: results disappointing

#86

Post by cycrutchfield » Tue, Mar 24, 2020, 5:24 PM UTC

jplayer01 wrote: post #80

cycrutchfield wrote: post #37

Thank goodness that we are actually getting some RCT results. There has been a huge confirmation bias towards any positive results for chloroquine, no matter how specious or flawed the underlying science was. Everybody wants this to work because the drug is well-tested on humans, cheap, and broadly available. It would be a panacea, a miracle drug. My concern is that the desire for this drug to be effective has cloude…

This study really isn’t sufficient proof for anything. Not even weak evidence. We need far better studies before deciding to give up on a drug.

It is definitely orders of magnitudes better than that flawed French study.

Re: First hydroxychloroquine randomized controlled trial: results disappointing

#87

Post by bdcravens » Tue, Mar 24, 2020, 8:07 PM UTC

hampelm wrote: post #69

Why are we amplifying someone posting a compressed jpeg to 3,000 followers who lists no name, has a photo of George Costanza, and claims to be a virologist?

Perhaps they are infinitely more qualified than some of the public figures pushing this treatment as a "game-changer"? Either way, hopefully we'll hear from some well-identified, qualified experts in time.

Re: First hydroxychloroquine randomized controlled trial: results disappointing

#88

Post by omgwtfbyobbq » Tue, Mar 24, 2020, 8:35 PM UTC

arcticbull wrote: post #39

omgwtfbyobbq wrote: post #24

Earlier quoted context omitted.

Like Reelin said, it's effectiveness may be related to it's ability to modulate immune activity by affecting pH. https://www.ncbi.nlm.nih.gov/pubmed/27927040 Course, that'll only work if the symptoms are being caused by an overactive immune system and it's able to mediate that immune response in time.

> Course, that'll only work if the symptoms are being caused by an overactive immune system and it's able to mediate that immune response in time. Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome [1]. HCQ is known to moderate this reaction. [1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

I'm not sure if it would be able to mitigate a cytokine storm, but it could prevent it. When DW was on it for sepsis due to an auto-inflammatory condition, her progression was much slower than what I've read about cytokine storm.

Re: First hydroxychloroquine randomized controlled trial: results disappointing

#89

Post by cycrutchfield » Tue, Mar 24, 2020, 8:42 PM UTC

solinent wrote: post #63

nikolay wrote: post #20

I am sorry, but isn't the mechanism of action that hydroxychloroquine is simply a zinc ionophore, i.e. you need enough free zinc in the blood for this to work? I read doctors suggesting using hydroxychloroquine along with 50mg of ionic zinc.

I've read about benefits not related to zinc, in addition to the zinc-related mechanism. It helps zinc get into the cell which prevents the replication of the virus, but there are additional benefits of this chemo medication. I'd have to take some time to find the particulars, if you read the original French study I think it details all the theoretical benefits. With any chemo drug I suspect it won't have a huge effe…

Hydroxychloroquine is not a chemo drug

Re: First hydroxychloroquine randomized controlled trial: results disappointing

#90

Post by mirimir » Tue, Mar 24, 2020, 8:49 PM UTC

arcticbull wrote: post #42

rurban wrote: post #22

Earlier quoted context omitted.

No, HCQ is the Antiviral. Anti-inflammatories are also in the plan, but not Iboprofen.

Not exactly. HCQ has anti-inflammatory action as well as immune moderating action [1] the latter of which may help protect against cytokine storm which occurs in some serious COVID-19 infections. It also has antiviral action in some situations but it's not clear that that's actually relevant to COVID-19 yet. [1] https://en.wikipedia.org/wiki/Hydroxychloroquine

Thanks. Upon reflecting, I meant to say immune moderating as well as anti-inflammatory. Which is why it's become so popular for treating arthritis.

I wonder about the antiviral activity, though. What I've read is about possibly faster drop in virus levels. And I suppose that HCQ could be interfering with some stage of intracellular virus production. But time will tell.