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Chloroquine, past and present

blogs.sciencemag.org

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Re: Chloroquine, past and present

#91

Post by gumby »

cameldrv wrote: post #62

We definitely want more studies, but IMO we're reaching a tipping point. We have anecdotal evidence from China and South Korea, and this quite flawed, but at least data-containing study from France. Chloroquine's safety profile isn't great, but the safety profile of COVID is way worse. If you look at Chemotherapy for example, one would never take any of those drugs unless you had cancer. COVID isn't quite as bad as c…

> Chloroquine's safety profile isn't great, but the safety profile of COVID is way worse. If you look at Chemotherapy for example, one would never take any of those drugs unless you had cancer.

The FDA's Office of new drugs is split into divisions (dermatology, oncology etc) and the different divisions have different approval criteria as you mention. From my Onco friends' PoV, cancer patients are pretty much assumed to be dying anyway so the standard of risk is quite different from, say, Derm, whose patients don't really die of anything except cancers.

Note: I have presented to the FDA and have written clinical trial requests (e.g. IND) which have been approved, but I have never done a submission to OOD. However my friends who do really talk about the approval path in a different way than I used to.

Don't self-medicate with chloroquine. It's very hepatotoxic.

Re: Chloroquine, past and present

#92

Post by ApolloFortyNine »

tibbydudeza wrote: post #88

A vaccine was developed in haste for an outbreak of swine flu in 1976 (CDC feared it was a repeat of 1918 flu) and about 45 million Americans received it but 450 people developed GBS (Guillaine-Barre Syndrome) as a result. Going on a hunch or unproven stuff is simply going to give the anti-vaxxer idiots further ammo

Taking your numbers as fact, that would be a .001% death rate.

Coronavirus has a death rate ranging from .6-2% (overall), varying drastically to upwards of 20% with age.

It's not a hard call to make.

Re: Chloroquine, past and present

#93

Post by travisporter »

axguscbklp wrote: post #72

It seems to me that we should immediately move to massively increase production of hydroxychloroquine. If it turns out to be part of a solution, great. If not, I doubt that more than a tiny fraction of the total resources dedicated to the pandemic would have been used up by the effort. There is no time to take things slowly in our situation. In any case, from what I've read on places like r/medicine, many people who…

Looks like they are!

"The generic drug companies (Teva and Mylan, I’ve seen so far, and there’s this) that are cranking up production are doing the prudent thing – if this reads out well, we’ll need a lot of it."

Re: Chloroquine, past and present

#94

Post by gnulinux »

mypalmike wrote: post #80
gnulinux wrote: post #61

Earlier quoted context omitted.

I read this X% success rate for many drugs, Remdesivir, chloroquine etc... What does it mean? Giving no drug, just ventilator alone has 97% success rate right? So how do we know that that 90% is due to the drug and not, you know, immune system itself? Moreover, a lot of people keep saying both Remdesivir and chloroquine are in official treatment suggestions in Italy, and seeing Italy is suffering a pretty bad mortali…

Was 97% a hypothetical? I have heard much lower figures for ventilator success rates.

Do they use these drugs only to severe patients who need ventilator? I was referring to the overall estimated CFR (3%). What is the success rate of ventilators then?

Re: Chloroquine, past and present

#95

Post by matsemann »

AdmiralBumbleB wrote: post #3

This chloroquinine rush is already out of control. My pharmacy is already out of it and is unable to procure from other pharmacies (which are also out already!) My pharmacist placed orders for all her patients to prefill prescriptions (where possible) for the next few months. I can understand a shortage when there's a clear evidence-based need, but the rumour-mill hasn't even ramped to full bore yet and it's already…

In Norway it has been restricted after doctors prescribed lots of it for themselves... Way to undermine the efforts.

Re: Chloroquine, past and present

#96

Post by ketamine__ »

AdmiralBumbleB wrote: post #3

This chloroquinine rush is already out of control. My pharmacy is already out of it and is unable to procure from other pharmacies (which are also out already!) My pharmacist placed orders for all her patients to prefill prescriptions (where possible) for the next few months. I can understand a shortage when there's a clear evidence-based need, but the rumour-mill hasn't even ramped to full bore yet and it's already…

I implore you to make a post on HN if you run out. From reading posts on HN I would suspect many have bought it online and may be willing to do the right thing and mail it to you.

Re: Chloroquine, past and present

#97

Post by aazaa »

Only one clinical study has been published on chloroquine (by a French group), and the results are lackluster. No patient was cleared of virus after six days using hydroxychloroquine alone. A tiny fraction of patients were cleared in 4 days using an adjunct therapy (azithromycin). The study itself has issues, and it's not even clear whether it will clear peer review.

The President is doing something very dangerous here with his comments in the last two days.

By stoking chloroquine hype, he's setting the country up for a massive disappointment should the drug fail to produce treatment, or unexpected side effects.

Although the drug has been used in humans for decades to treat malaria, it has not been used to any extent on humans to treat COVID-19. There's a non-zero chance of adverse reactions, potentially serious given known problems with the chloroquines.

Even worse, the idea that a "treatment" exists will encourage people to let down their guard and will very likely lead to even worse outbreaks.

Unexpected things happen all the time in clinical trials. This is the main reason it costs billions to bring a drug to market. We can't predict jack squat.

Re: Chloroquine, past and present

#98

Post by arrrg »

cameldrv wrote: post #62

We definitely want more studies, but IMO we're reaching a tipping point. We have anecdotal evidence from China and South Korea, and this quite flawed, but at least data-containing study from France. Chloroquine's safety profile isn't great, but the safety profile of COVID is way worse. If you look at Chemotherapy for example, one would never take any of those drugs unless you had cancer. COVID isn't quite as bad as c…

The study from France seems to suck, though. Not very valuable data.

They measured virus, not outcomes, they measured virus in the throat, not the lungs, the starting point was not the start of the disease but some later (more arbitrary) point in time, the two groups were not randomly assigned and the study wasn’t really blind.

It could be that they just happened to compare two groups where the treatment group was further along in the illness – especially since they try to sell that as a disadvantage for them, but that could honestly be an advantage for them. We know that virus in the throat decreases as the illness progresses. (Virus in the lungs is much more relevant and also dangerous here, better would probably be outcomes.)

Not really evidence, sorry.

Re: Chloroquine, past and present

#99

Post by gnulinux »

cameldrv wrote: post #77
stcredzero wrote: post #70

Earlier quoted context omitted.

> COVID isn't quite as bad as cancer, but Chloroquine, especially for a short course, isn't anywhere near as bad as most chemo drugs. For certain individuals who just happen to have a bad reaction, COVID could well be just as fatal as cancer. In terms of how fast it can kill people, in certain cases, it can be worse than a lot of cancers.

Do you mean COVID is as fatal as cancer or Chloroquine is?

COVID. For >70 y.o. individuals mortality rate is 30%. If you're >70 y.o. have heart condition and have diabetes (all risk factors) COVID is clearly more deadly than some (most?) cancers, not to mention it kills in the order of weeks, when cancer kills in the order of months or years.

Re: Chloroquine, past and present

#100

Post by BurningFrog »

guiriduro wrote: post #48

Is there not an argument that given chloroquine's apparent efficacy, albeit statistically weakly or improperly demonstrated (so far), along with its long history of relative safety in anti-malarial prophylaxis (with known caveats), set against an exponential growth in dangerous pneumonia - it is therefore rational to want to at least offer it to all suspected cases and healthworkers in balance of the serious risks th…

Sure, but what is rational and what's allowed by the FDA are entirely separate things.

I expect to see a lot of exploring of this outside the US. Maybe once bolder countries have sorted things out, we can use their findings.

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