New study on Hydroxychloroquine for Covid: No benefit in non-critical hospitalized

[blueash]

I am not saying that HCQ with or without other therapeutics is of benefit or not. I am just reporting every study I can find.

This is from France. They looked back at the records from 4 hospitals of all patients who were ill enough to be admitted and required oxygen help, but not ICU ill at the time of admission. Then they analyzed the hospital course comparing those who did vs did not get HCQ. The patients were not randomized but the authors used the records to check whether the treated vs the untreated patients differed on admission in several ways.

Interestingly "All comorbidities were less frequent in the HCQ group." This would mean that the likelihood of progressing to severe illness would theoretically be higher in the NOT treated group as they had more comorbidities. The differences were trends, not significantly different.

84 patients received HCQ, 97 did not receive HCQ.

20.5% patients in the HCQ group were transferred to the ICU or died within 7 days, compared with 22.1% in the no-HCQ group

For the secondary outcomes,
2.8% of patients in the HCQ group died within 7 days,
compared with 4.6% in the no-HCQ group

Similarly, 27.7% of the HCQ group and
24.1% of the no-HCQ group developed ARDS within 7 days
None of these are significant differences. See the article for full statistical analysis.

This study showed no benefit on any of the measures examined. This is limited to patients admitted with an oxygen requirement but not ICU ill on admission.

You can read the details HERE (https://www.medrxiv.org/content/10.1101/2020.04.10.20060699v1.full.pdf). Note this is pre-publication and not yet peer reviewed.

[Bogie Shooter]

It’s not the statistics...........it’s gut feel as to it working or not.

[Marvic 1]

- MedRxiv -
"Caution: Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information."

I'm surprising The New York Times didn't think of this first to publish...

[GoodLife]

I am not saying that HCQ with or without other therapeutics is of benefit or not. I am just reporting every study I can find

You must have missed this one.

62 patients were identified as having COVID-19 and enrolled in this study, none quit (Figure 1). As shown in Table 1, For all patients, the age was 44.7 (15.3) years old, 46.8% (29 of 62) were male and 53.2% (33 of 62) were female. Patients were randomly assigned into two groups. There was no significant difference in the age and sex distribution between the two groups of patients, but there are significant differences in TTCR between the two groups. For fever, 17 patients in the control group and 22 patients in the HCQ treatment group had a fever in day 0. Compared with the control group [3.2 (1.3) days], the body temperature recovery time was significantly shortened in the HCQ treatment group [2.2 (0.4) days]. For cough, 15 patients in the control group and 22 patients in the HCQ treatment group had
a cough in day 0, The cough remission time was significantly reduced in the HCQ treatment group. Notably, a total of 4 of the 62 patients progressed to severe illness, all of which occurred in the control group not receiving HCQ treatment. For adverse effects, it should be noted that there were two patients
with mild adverse reactions in the HCQ treatment group, one patient developed a rash, and one patient experienced a headache, none severe side effects appeared among them.

To further explore the effect of HCQ on pneumonia, we compared and analyzed the chest CT of patients on day 0 and day 6. In our study, pneumonia was improved in 67.7% (42/62) of patients, with 29.0% moderately absorbed and 38.7% significantly improved. Surprisingly, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 31) compared with the control group (54.8%, 17 of 31). Besides, 61.3% of patients in the HCQ treatment group had a significant pneumonia absorption.

https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2.full.pdf

[starflyte1]

I used to buy almost every diet book published. My late husband said if you buy enough, one will eventually say what you want to read.

I am getting the feeling that could apply to these studies.

Stay well!

[blueash]

I am not saying that HCQ with or without other therapeutics is of benefit or not. I am just reporting every study I can find

You must have missed this one.

https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2.full.pdf

Nice try, didn't miss it

https://www.talkofthevillages.com/forums/medical-health-discussion-94/new-study-hydroxychloroquine-azithromycin-failure-304723/#post1738792

I specifically noted this positive study

Thanks for playing

[JP]

Tom Hanks and his wife took it. Hmmm......

[blueash]

- MedRxiv -
"Caution: Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information."

I'm surprising The New York Times didn't think of this first to publish...

Did you not see this in my post?

Note this is pre-publication and not yet peer reviewed.

The NY Times is an excellent source of information on science and I commend you for noticing that publication. They do not publish original research.

In fact the NY Times does cover Covid research including a lengthy article on April 1 reporting the details of the study I was attacked for not mentioning, even though I did mention it in an earlier thread. Thus a positive study on HCQ was covered as the NY Times does not ignore findings either way, and neither do I.

The article begins
The malaria drug hydroxychloroquine helped to speed the recovery of a small number of patients who were mildly ill from the coronavirus, doctors in China reported this week.
Cough, fever and pneumonia went away faster, and the disease seemed less likely to turn severe in people who received hydroxychloroquine than in a comparison group not given the drug. The authors of the report said that the medication was promising, but that more research was needed to clarify how it might work in treating coronavirus disease and to determine the best way to use it. and goes on to explain the details, the strengths and weaknesses of the data and has comments from clinicians to understand the import of the evidence. It is an excellent article. Look it up.

[blueash]

Tom Hanks and his wife took it. Hmmm......

And what does that prove to you? Science is not advanced by anecdotes. Over 80 patients took it in the above study without benefit. The evidence is still murky. It may help - it may hurt it - may do nothing. The important part of a negative report it that it disproves the claim that HCQ is a miracle that will benefit a large percentage of the ill people who receive it. That part is clearly wrong in the patient population studied. If it helps some, that evidence is not yet established or disproven.

[eyc234]

Now also "studies" out of South America that heart ailments are showing up in individuals using the drug. Is this not like the commercials that say if you start to bleed from your eyes or are allergic to this medication stop taking it! If you are on your last gasp, yes it could save you but it also could hurt you. How would it react with the other 15 drugs that you are on, not to mention the innumerable vitamins and supplements some people take. It may work but it is far from a proven cure and should not be touted in any shape or form as such, more of a last resort or option if you are not getting better.

[GoodLife]

Nice try, didn't miss it

https://www.talkofthevillages.com/forums/medical-health-discussion-94/new-study-hydroxychloroquine-azithromycin-failure-304723/#post1738792

I specifically noted this positive study

Thanks for playing

Thanks for playing? Are we teenagers now?

Let's see how you "specifically noted this positive study"

First of all, you made a comment about it in a post titled "New study on hydroxychloroquine with azithromycin, failure"

So lets look at your comments about this "positive" study:

And today a new study. This out of China so some of you don't believe anything out of China can ignore this one, unless of course it fits your preconceived ideas.

What a nice snarky positive introduction! Most of us don't believe the Chinese government, their Doctors are another matter, especially since many of them keep getting disappeared.

This study was randomized with a control group. It has not been peer reviewed. It was done on patients with mild disease, not severe disease.

I don't know about you, I'd rather be cured before going on the ventilator.

So this is not a study of HCQ, rather it is a study of HCQ given with antivirals, antibacterials, immunoglobin, and sometimes steroids. Keep the findings clear in your mind that therefore this study does not show that HCQ by itself benefits. Only that HCQ when added to all those other interventions shows benefit.

That's strange, the team of Doctors who made this study titled it "Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial"

You better let them know.

You keep arguing against a strawman, nobody that I read about is saying "Hydroxychloroquine is the cure! Take it and we're saved! All Doctors that I know of are using it in combination with other drugs. All the patients in this study got the same drugs, except the control group did not receive hydroxychloroquine. None of the HCQ recipients died, while 4 in the control group did. HCQ recipients also statistically improved faster for coughs and fevers. I did not see a p value for the pneumonia results, just their comment in results:

"Surprisingly, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 31) compared with the control group (54.8%, 17 of 31). Besides, 61.3% of patients in the HCQ treatment group had a significant pneumonia absorption."

Sounds like a pretty good study, with good results. If you promoted the good ones equally to the failures, then I might believe you are unbiased.

[skyking]

I am not saying that HCQ with or without other therapeutics is of benefit or not. I am just reporting every study I can find.

This is from France. They looked back at the records from 4 hospitals of all patients who were ill enough to be admitted and required oxygen help, but not ICU ill at the time of admission. Then they analyzed the hospital course comparing those who did vs did not get HCQ. The patients were not randomized but the authors used the records to check whether the treated vs the untreated patients differed on admission in several ways.

Interestingly "All comorbidities were less frequent in the HCQ group." This would mean that the likelihood of progressing to severe illness would theoretically be higher in the NOT treated group as they had more comorbidities. The differences were trends, not significantly different.

84 patients received HCQ, 97 did not receive HCQ.


None of these are significant differences. See the article for full statistical analysis.

This study showed no benefit on any of the measures examined. This is limited to patients admitted with an oxygen requirement but not ICU ill on admission.

You can read the details HERE (https://www.medrxiv.org/content/10.1101/2020.04.10.20060699v1.full.pdf). Note this is pre-publication and not yet peer reviewed.

So 47 is a "small study" but 181 is a statistically valid study. I knew my statistics professor was misinformed. Or is it if the findings agree with your position which make it relevant?

[MOMOH]

FROM MY FRIEND, THE DOCTOR:
"If you pay any attention to the news, you could be forgiven for thinking that there's a big medical controversy about whether the drug hydroxychloroquine is a miracle cure for COVID19 (the disease caused by the virus SARS-CoV2, like AIDS is the disease caused by the virus HIV).

Hydroxychloroquine is a drug that's used mainly to treat a number of different autoimmune conditions, most commonly lupus (but also rheumatoid arthritis, mixed connective tissue disease, among others). It's a derivative of an old malaria drug, chloroquine, which itself is a derivative of quinine, the substance that gives tonic water it's bitter taste. This is why the British invented the gin and tonic, to protect against malaria in India.

Hydroxychloroquine (trade name plaquenil) is chemically similar to chloroquine and quinine but with fewer side effects. It's thought to be helpful against COVID because it has antiviral action in a test tube and blocks the entry of the virus into our cells. And because it modulates the immune system, it may help to tamp down on the body's "cytokine storm" when infected with COVID, which is a complicated way of saying that the body's immune system goes so crazy fighting the infection that it ends up causing damage beyond what would just be caused by the virus. Hence why a drug used for autoimmune conditions may make sense.

Hydroxychloroquine is generally combined with azithromycin and zinc for treatment of COVID patients. The azithromycin is an antibiotic that also has antiinflammatory (read: immune system modulating and not antiviral) effects. Zinc supplementation has been shown to shorten the duration of a cold by about a day. So this cocktail is hypothesized to help the body get through the COVID infection.

The reason this has been in the news is obvious - Trump purports it to be a miracle drug and has been recommending that people take it. There's some low quality research that's shown a benefit of this drug in COVID patients. Low quality meaning that it could be correct but could also be a false signal. Because there hasn't been a randomized trial (the only real way to prove the benefit of any medical intervention) all we can see are associations. Correlation is not causation.

There are also some anecdotal reports of people getting better with it that the news is running with, although the degree to which this is due to the drug versus due to the natural history of infection or regression to the mean is anyone's guess. The plural of anecdote is not data.

And then there's pushback to the idea that it's of any use from researchers here along with the mixed messages we have been getting from both experts and "experts." Tony Fauci is suggesting that we need to study it more. Dr. Oz is suggesting that it's the best thing he's seen since sea buckthorn oil. And a whole bunch of armchair medical experts, idiots on cable news, and random people on Twitter are suggesting that they're now plaquenil/COVID experts and can't believe the medical establishment won't let us have these life saving meds.

Like most things on cable news, the discussion is much dumber than it should be and misinforms more than it informs.

I have been taking care of critically ill COVID patients on ventilators and talking with lots of colleagues and friends who are also taking care of these patients.

We are ALREADY giving these medications to all patients who are super sick with COVID. Truly - almost all patients across the country admitted to the hospital with COVID are being given hydroxychloroquine and azithromycin twice a day. Not an exaggeration to say that almost all of them are already getting it.

It's clearly not a miracle concoction, because if it was, people wouldn't be dying from this disease left and right. The idea that hydroxychloroquine may do anything other than help a bit on the margins is ridiculous. Of course it might be slightly beneficial, but anyone who thinks that there's any possibility it's a wonder drug hasn't taken care of any COVID patients and hasn't talked to anyone taking care of COVID patients.

I think it's totally reasonable to give plaquenil to COVID patients. Reducing the entry of the virus into cells and tamping down on our own immune response with a drug that's pretty well tolerated makes sense as long as someone isn't developing side effects, and most people do fine with it.

Some hospitals are giving it to their healthcare workers for prophylaxis. This is, again, totally reasonable in my eyes, but again, it's not a miracle drug. Masks, gloves, and hand washing are way more likely to be effective in reducing the spread of the virus.

So what do you have to lose? The obvious downside is that all medications have side effects and plaquenil is no different. The major issue that it can cause is a cardiac rhythm problem called "Torsades de pointes" which is a life-threatening abnormal heart rhythm related to medications that block a channel in the heart. There's a genetic component of risk, but most of it is idiosyncratic and unpredictable. When plaquenil is combined with azithromycin, the risk is much greater. We would generally be following daily EKGs on patients on these drugs when they're in the hospital, but because of limitations in PPE, we've been resorting to suboptimal monitoring of something called the QTc interval, which is what is related to risk of Torsades.

The other risk that's much more rare is cardiovascular collapse related to plaquenil ("plaquenil induced cardiomyopathy"). I saw one case of this in residency, where a patient basically died over the course of a few hours related to plaquenil use. This is really rare and a low probability event, but it can happen. Although it seems to be related to total quantity of the medication taken over a lifetime, if we suddenly give it to millions of people, we are going to see some cases. There's no free lunch in medicine.

In my eyes, the bigger downside is that focus on hydroxychloroquine distracts attention from other things that could have a bigger impact. There are a lot of potential treatments that can help before a vaccine is developed, and we really need to figure out what works and what doesn't in COVID, not just guess about it and assume we are right. Spending a lot of time and resources arguing about hydroxychloroquine is a distraction."

[Annie66]

Tom Hanks and his wife took it. Hmmm......

One data point, even two, is not a trend.

[Annie66]

FROM MY FRIEND, THE DOCTOR:
"If you pay any attention to the news, you could be forgiven for thinking that there's a big medical controversy about whether the drug hydroxychloroquine is a miracle cure for COVID19 (the disease caused by the virus SARS-CoV2, like AIDS is the disease caused by the virus HIV).

Hydroxychloroquine is a drug that's used mainly to treat a number of different autoimmune conditions, most commonly lupus (but also rheumatoid arthritis, mixed connective tissue disease, among others). It's a derivative of an old malaria drug, chloroquine, which itself is a derivative of quinine, the substance that gives tonic water it's bitter taste. This is why the British invented the gin and tonic, to protect against malaria in India.

Hydroxychloroquine (trade name plaquenil) is chemically similar to chloroquine and quinine but with fewer side effects. It's thought to be helpful against COVID because it has antiviral action in a test tube and blocks the entry of the virus into our cells. And because it modulates the immune system, it may help to tamp down on the body's "cytokine storm" when infected with COVID, which is a complicated way of saying that the body's immune system goes so crazy fighting the infection that it ends up causing damage beyond what would just be caused by the virus. Hence why a drug used for autoimmune conditions may make sense.

Hydroxychloroquine is generally combined with azithromycin and zinc for treatment of COVID patients. The azithromycin is an antibiotic that also has antiinflammatory (read: immune system modulating and not antiviral) effects. Zinc supplementation has been shown to shorten the duration of a cold by about a day. So this cocktail is hypothesized to help the body get through the COVID infection.

The reason this has been in the news is obvious - Trump purports it to be a miracle drug and has been recommending that people take it. There's some low quality research that's shown a benefit of this drug in COVID patients. Low quality meaning that it could be correct but could also be a false signal. Because there hasn't been a randomized trial (the only real way to prove the benefit of any medical intervention) all we can see are associations. Correlation is not causation.

There are also some anecdotal reports of people getting better with it that the news is running with, although the degree to which this is due to the drug versus due to the natural history of infection or regression to the mean is anyone's guess. The plural of anecdote is not data.

And then there's pushback to the idea that it's of any use from researchers here along with the mixed messages we have been getting from both experts and "experts." Tony Fauci is suggesting that we need to study it more. Dr. Oz is suggesting that it's the best thing he's seen since sea buckthorn oil. And a whole bunch of armchair medical experts, idiots on cable news, and random people on Twitter are suggesting that they're now plaquenil/COVID experts and can't believe the medical establishment won't let us have these life saving meds.

Like most things on cable news, the discussion is much dumber than it should be and misinforms more than it informs.

I have been taking care of critically ill COVID patients on ventilators and talking with lots of colleagues and friends who are also taking care of these patients.

We are ALREADY giving these medications to all patients who are super sick with COVID. Truly - almost all patients across the country admitted to the hospital with COVID are being given hydroxychloroquine and azithromycin twice a day. Not an exaggeration to say that almost all of them are already getting it.

It's clearly not a miracle concoction, because if it was, people wouldn't be dying from this disease left and right. The idea that hydroxychloroquine may do anything other than help a bit on the margins is ridiculous. Of course it might be slightly beneficial, but anyone who thinks that there's any possibility it's a wonder drug hasn't taken care of any COVID patients and hasn't talked to anyone taking care of COVID patients.

I think it's totally reasonable to give plaquenil to COVID patients. Reducing the entry of the virus into cells and tamping down on our own immune response with a drug that's pretty well tolerated makes sense as long as someone isn't developing side effects, and most people do fine with it.

Some hospitals are giving it to their healthcare workers for prophylaxis. This is, again, totally reasonable in my eyes, but again, it's not a miracle drug. Masks, gloves, and hand washing are way more likely to be effective in reducing the spread of the virus.

So what do you have to lose? The obvious downside is that all medications have side effects and plaquenil is no different. The major issue that it can cause is a cardiac rhythm problem called "Torsades de pointes" which is a life-threatening abnormal heart rhythm related to medications that block a channel in the heart. There's a genetic component of risk, but most of it is idiosyncratic and unpredictable. When plaquenil is combined with azithromycin, the risk is much greater. We would generally be following daily EKGs on patients on these drugs when they're in the hospital, but because of limitations in PPE, we've been resorting to suboptimal monitoring of something called the QTc interval, which is what is related to risk of Torsades.

The other risk that's much more rare is cardiovascular collapse related to plaquenil ("plaquenil induced cardiomyopathy"). I saw one case of this in residency, where a patient basically died over the course of a few hours related to plaquenil use. This is really rare and a low probability event, but it can happen. Although it seems to be related to total quantity of the medication taken over a lifetime, if we suddenly give it to millions of people, we are going to see some cases. There's no free lunch in medicine.

In my eyes, the bigger downside is that focus on hydroxychloroquine distracts attention from other things that could have a bigger impact. There are a lot of potential treatments that can help before a vaccine is developed, and we really need to figure out what works and what doesn't in COVID, not just guess about it and assume we are right. Spending a lot of time and resources arguing about hydroxychloroquine is a distraction."

Thank you for the point of view from a knowledgeable individual fighting this illness on the front line. Objective, unemotional commentary is needed more today than ever before.

[davem4616]

when I was diagnosed with a form or cancer that had no treatment other than surgical removal and had maybe an 11% chance I would have agreed to anything that was out there that could possibly help and give me hope...that was 30 years ago

If I come down with covid-19, I could care less about whether some preliminary French research study was right or wrong.....gimme the HCQ and help me fight this thing

[toeser]

I have read of multiple doctors (From France and the U.S.) claiming success with their treatment using hydroxychloroquine, but always in combination with other drugs. Zinc has been mentioned more than once as a combination treatment.

[Gramjan]

Finally, the voice of reason......T.Y.
Finally, the Voice of Reason. T.Y., Momoh

[Nanny32162]

I am not saying that HCQ with or without other therapeutics is of benefit or not. I am just reporting every study I can find.

This is from France. They looked back at the records from 4 hospitals of all patients who were ill enough to be admitted and required oxygen help, but not ICU ill at the time of admission. Then they analyzed the hospital course comparing those who did vs did not get HCQ. The patients were not randomized but the authors used the records to check whether the treated vs the untreated patients differed on admission in several ways.

Interestingly "All comorbidities were less frequent in the HCQ group." This would mean that the likelihood of progressing to severe illness would theoretically be higher in the NOT treated group as they had more comorbidities. The differences were trends, not significantly different.

84 patients received HCQ, 97 did not receive HCQ.


None of these are significant differences. See the article for full statistical analysis.

This study showed no benefit on any of the measures examined. This is limited to patients admitted with an oxygen requirement but not ICU ill on admission.

You can read the details HERE (https://www.medrxiv.org/content/10.1101/2020.04.10.20060699v1.full.pdf). Note this is pre-publication and not yet peer reviewed.
This is from The Hill
"The CIA advised employees that taking an anti-malarial drug that has been touted by President Trump and others as a potential treatment for coronavirus could have potentially dangerous side effects, including death, The Washington Post reported.

The warning was reportedly published on a website for CIA staff with questions related to the coronavirus pandemic late last month.

“At this point, the drug is not recommended to be used by patients except by medical professionals prescribing it as part of ongoing investigational studies. There are potentially significant side effects, including sudden cardiac death, associated with hydroxychloroquine and its individual use in patients need to be carefully selected and monitored by a health care professional,” read a response to an employee who asked whether they should take the drug without a prescription, according to the Post."

[croughwell]

Did you ready the actual studies or someone's interpretation?

[Byte1]

So, let me get this straight. If you are afflicted with a life threatening illness and someone offers you something that may or may not cure you, you will refuse it because it has not been certified as being 100% effective? Okkkkkk???

[Twiganne]

Here are my thoughts. If I am really sick with the virus, and before I crash and burn, I am asking my doctor for a prescription. I watched an interesting YouTube video yesterday by a pharmacist who explained the reason Zinc is given with the drug. The ions of both drugs are both charged and have positive and negative charges. The zinc was added added to open up the cells and allow the antiviral to actually enter the lung cells to be effective.

[blueash]

So 47 is a "small study" but 181 is a statistically valid study. I knew my statistics professor was misinformed. Or is it if the findings agree with your position which make it relevant?

I don't actually understand the point you are making. Of course with a larger sample size it is easier to detect statistically significant differences. It is also easier to detect that sample groups do not differ significantly. Yes, 181 is greater than 47. Thus a study with 181 data points if looking at the same conditions, for the same outcomes, with the same variables... Will be a stronger study.

I do not have a position on whether or not HCQ works. I have made that clear over and over and over. I do have a position on whether it has been shown to beneficial in well conducted studies. It has not. Will it be shown to be beneficial in studies now ongoing. I don't know. I believe in the scientific method, not making judgement about efficacy by gut feeling.

So this particular retrospective chart review had enough numbers that its findings should be considered a possible refutation of extreme benefit of HCQ for Rx of Covid in the patient type studied. I did point out in my initial post that this is not peer reviewed nor published yet, as I have in I believe every study I have mentioned from the medrxiv.

I will continue to read the literature daily. I will continue to post updates to TOTV on both positive and negative outcomes. I will continue to point out what I believe are cautions to be considered in study design, patient selection, randomization, etc.

Some proponents of HCQ have claimed, as linked on TOTV, that they see nearly 100% recoveries with the drug given alone . Sometimes they claim it only works if given with azithromycin. Those two claims cannot both be true. Others claim that it doesn't work unless you give it with zinc. So that's three separate protocols each claiming a high rate of benefit, but 2 of the 3 saying the other two would fail. The "need zinc" guy says HCQ fails if taken alone or taken only with Zith. The "you need zith" guy says if you only add zinc to HCQ you have missed the needed booster.

This thread is about treating or not treating moderately ill hospitalized Covid patients with HCQ and seeing if it helped.

Interpretation
These results do not support the use of HCQ in patients hospitalised for documented SARS CoV-2-positive hypoxic pneumonia.
If you want to discuss statistics I refer you back to the actual paper HERE (https://www.medrxiv.org/content/10.1101/2020.04.10.20060699v1.full.pdf) in which the authors inform you of the statistical tools used in great detail.

"Statistical analysis
An inverse probability of treatment weighting (IPTW) approach was used to “emulate” randomisation and balance the differences in baseline variables between treatment groups.10,11 A non-parsimonious multivariable logistic regression model was constructed to estimate each patient’s probability of receiving HCQ given their baseline covariates (i.e., the propensity score). Variables of the propensity score (PS) model were planned and prespecified before outcome analyses and included …." and it goes on for nearly an entire page.

The results section lists both relative risk [RR] AKA odds ratio and the confidence interval [CI] for each outcome measured. Please look at those statistics and let me know if the sample size in this study was large enough to produce useful numbers.

My statistics professor did a good job too. I don't think mine was misinformed.

[theruizs]

Thanks for the info. They say it isn’t significant, meaning statistically significant. So it is possible the difference is margin of error or something else. But given they see it in all three measures, it would seem to indicate some benefit. I would imagine that those who did improve, or survived, consider it quite significant. BTW, they are also finding that some critical patients are actually having a sort of anti-body/cytokine storm in response to the virus that is causing critical issues. Treating with an immune damping drug has helped in those patients once they are identified. Hopefully this is another key factor they can look for and treat successfully. Emergency room doctor, near death with coronavirus, saved after experimental treatment (https://www.yahoo.com/news/emergency-room-doctor-near-death-054816082.html)

[GoodLife]

I will continue to post updates to TOTV on both positive and negative outcomes.

Sure you will. Your two threads on hydroxychloroquine

New study on Hydroxychloroquine for Covid: No benefit in non-critical hospitalized

New study on Hydroxychloroquine with Azithromycin, failure

I see a trend here.

[DonnaNi4os]

I am a lupus patient and have been on hydroxychloroquine for 18+ years. I have heard that the propensity to acquire COVID-19 is very low for patients who have been on it for a length of time. Other reports say I would still be at risk so I am taking the recommended precautions.

[blueash]

I have read of multiple doctors (From France and the U.S.) claiming success with their treatment using hydroxychloroquine, but always in combination with other drugs. Zinc has been mentioned more than once as a combination treatment.

There have been claims that HCQ by itself is a miracle cure and thus does not need any other drug to work. There are those that say it is useless without zinc including a doctor whose proof of necessity was posted on TOTV

Dr. Anthony Cardillo said he has seen very promising results when prescribing hydroxychloroquine in combination with zinc for the most severely-ill COVID-19 patients.

"Every patient I've prescribed it to has been very, very ill and within 8 to 12 hours, they were basically symptom-free," Cardillo told Eyewitness News. "So clinically I am seeing a resolution." He said he has found it only works if combined with zinc.

This is completely contrary to what other users claim is needed. This is the kind of claim made for snake oil, not medicines. If he said that zinc may help in some cases, ok. But to say that HCQ with zinc has made very very ill patients symptom free in 12 hours is so contrary to your common sense that such snake oil salesmen shouldn't be on the news or be spouting uncorrected nonsense. You don't need a background in medicine to know what he said cannot be true or we wouldn't have any more very very ill patients as every doctor would be doing this alleged miracle treatment.

And interestingly the link provided in Goodlife's (https://abc7.com/health/doctors-say-caution-needed-in-drug-treatment-for-covid-19/6082485/) posting to the eyewitness news story does not have the 8 to 12 hour claim nor the only works with zinc claim and is full of advisories about how he has only given it to 5 patients in his practice and the other 90 all got better without treatment. Also that it should only be used on hospital level illness and is anecdotal and "first do no harm." There is no indication the article was edited on the website.

[blueash]

I am a lupus patient and have been on hydroxychloroquine for 18+ years. I have heard that the propensity to acquire COVID-19 is very low for patients who have been on it for a length of time. Other reports say I would still be at risk so I am taking the recommended precautions.

First, best wishes in managing your lupus. HCQ is an excellent well studied medication for lupus. As you certainly are aware it does not cure lupus rather it lowers disease severity. SLE makes you higher risk. Please follow the recommendations you have heard about hand washing, social distancing etc. Be safe. Do not assume your HCQ will protect you.

There have been some attempts to determine whether people on HCQ for lupus or other reasons have a decreased risk of illness from COVID. There is an online registry (https://rheum-covid.org/) of patients with rheumatological diseases and COVID entering their own data, thus not a reliable resource. As of April 10 there are 234 patients. 29% of the COVID patients were on HCQ when they became ill.

April 4 2020 “They should look at the lupus thing. I don’t know what it says, but there’s a rumor out there that because it takes care of lupus very effectively as I understand it, and it’s a, you know, a drug that’s used for lupus,” ... said during the briefing. “So there’s a study out there that says people that have lupus haven’t been catching this virus. Maybe it’s true, maybe it’s not.”

This is an example of someone telling you he does not know what "it says" then spreads a "rumor" Then says there is "a study" then says maybe or maybe not. This not useful information and I understand why you have had a hard time figuring out what the person understands or is trying to say. In summary this is a rumor of the non-results of a non-existent study being stated as a non-fact by an imprecise barker. Argle bargle

There is no study out there I can find. Fact checkers have asked for evidence of the study from the above person, and not been provided with evidence.

[rrb48310]

Tom Hanks and his wife took it. Hmmm......


Did you see Tom Hanks wife, Rita, telling what she experienced? Nauseous and couldn’t walk. Did it help??? Point being let the studies play out, it’s been such a short time and the best of the best, and all the rest, worldwide are working on it.

[EVH234591]

I'm thinking you are probably right.

[Reesie]

Tom Hanks and his wife took it. Hmmm......

I watched her interview. Her symptoms were worse than Tom’s. She didn’t say anything about if he took it, only about her bad reactions to the drug.
I’m only saying this because, it is an option. It is not totally proven. It is a prescription medicine. Don’t demand. Ask. Ask if this is an option for you.

[rrb48310]

I watched her interview. Her symptoms were worse than Tom’s. She didn’t say anything about if he took it, only about her bad reactions to the drug.
I’m only saying this because, it is an option. It is not totally proven. It is a prescription medicine. Don’t demand. Ask. Ask if this is an option for you.

Yep
Link to clinical trials,

Search of: Covid-19 - List Results - ClinicalTrials.gov (https://clinicaltrials.gov/ct2/results?cond=Covid-19&term=hydroxychloroquine&cntry=&state=&city=&dis t=)

[Aloha1]

Did you see Tom Hanks wife, Rita, telling what she experienced? Nauseous and couldn’t walk. Did it help??? Point being let the studies play out, it’s been such a short time and the best of the best, and all the rest, worldwide are working on it.
Weakness with difficulty walking and nausea are symptoms of the Wuhan virus, not necessarily from hydroxychloroquine.

[blueash]

I will continue to post updates to TOTV on both positive and negative outcomes.

Sure you will. Your two threads on hydroxychloroquine

New study on Hydroxychloroquine for Covid: No benefit in non-critical hospitalized

New study on Hydroxychloroquine with Azithromycin, failure

I see a trend here.

You are absolutely correct about that. The trend is that the recent are showing no benefit. That trend may reverse or may not. You posted that I have omitted positive results and posted a study details. I then showed you that I did post about that study in detail. And I have posted about the initial French study. I am not saying there may not be more studies I may have missed. That is going to happen if it has not already.

When a new study appears that shows benefit I now promise you I will start a new thread rather than include that study in an existing thread. Does that make you happier?

I would like HCQ to work. It is cheap, it is mostly available, it is generic, its side effect profile is well known, the specific monitoring needs are established. You don't seem to believe that is my hope, but it is. IMO it is being promoted as a near certain cure by one segment of our country without science based evidence to support that near certainty. When someone says I hear this works, it's great, you should take this, then perhaps throws in a maybe, maybe not, that is not a balanced presentation. That's an endorsement with a caveat.
The science is not endorsing this drug with or without other medications. And talking heads on TV or online should not be suggesting that the science is clearly pointing in one direction, or the other. I will continue to look for studies. I don't know the best evidence conclusion yet. I welcome your continued input. I look forward to you perhaps even finding and posting a negative result once.

Remember when you used to hear the phrase "fair and balanced" I think my approach re HCQ has been both. YMMV

[jklfairwin]

It is indeed a sad commentary on our times that, based on the comments and replies here, one's approach to medical information is based on one's tribal loyalties s to either Trump or not Trump.

[GoodLife]

You are absolutely correct about that. The trend is that the recent are showing no benefit. That trend may reverse or may not. You posted that I have omitted positive results and posted a study details. I then showed you that I did post about that study in detail. And I have posted about the initial French study. I am not saying there may not be more studies I may have missed. That is going to happen if it has not already.


When a new study appears that shows benefit I now promise you I will start a new thread rather than include that study in an existing thread. Does that make you happier?

I would like HCQ to work. It is cheap, it is mostly available, it is generic, its side effect profile is well known, the specific monitoring needs are established. You don't seem to believe that is my hope, but it is. IMO it is being promoted as a near certain cure by one segment of our country without science based evidence to support that near certainty. When someone says I hear this works, it's great, you should take this, then perhaps throws in a maybe, maybe not, that is not a balanced presentation. That's an endorsement with a caveat.

The science is not endorsing this drug with or without other medications. And talking heads on TV or online should not be suggesting that the science is clearly pointing in one direction, or the other. I will continue to look for studies. I don't know the best evidence conclusion yet. I welcome your continued input. I look forward to you perhaps even finding and posting a negative result once.

Remember when you used to hear the phrase "fair and balanced" I think my approach re HCQ has been both. YMMV

Yes, that will make me happy. In your comment about the Chinese study with control group, you Implied it didn't mean anything because other drugs were involved. Pretty much every study involves a cocktail of drugs. The difference from the two groups was HCQ, and the HCQ group did better, no deaths, faster improvement.

Do you actually think because you know who said things like "It may or may not work" "I'm not a doctor" and "I may take it, I'll have to ask my doctors" that 1000s of Doctors are now prescribing HCQ in combination with other drugs all over the world? That's basically saying all these doctors actually treating covid 19 are complete dummies.

[blueash]

In your comment about the Chinese study with control group, you Implied it didn't mean anything because other drugs were involved. Pretty much every study involves a cocktail of drugs. The difference from the two groups was HCQ, and the HCQ group did better, no deaths, faster improvement.


In every study both positive and negative I look for confounding factors The referenced study from China (https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v3.full.pdf) never informs the reader how the other treatments were distributed between the control and drug arms. Most other studies include that information, not all. Your note about no deaths is striking as it would lead the reader to be misled as it implies there were no deaths in the HCQ arm as a difference. I'd gently point out there were no deaths in the control arm either. None of the patients in the study had died in either group. The only significant differences between the treated and the control groups were as listed by the authors:

Compared with the [17 patients] control group [3.2 (1.3) days], the body temperature recovery time was significantly shortened in the HCQ [22 patients] treatment group [2.2 (0.4) days]. This means the treated group had one fewer day of fever. The authors did not show the statistical measures used to see if this was significant. Most papers give a p value or similar measure and a confidence interval. There are none in the paper given although the authors state an analysis was done.

For cough, 15 patients in the control group and 22 patients in the HCQ treatment group had a cough in day 0, The cough remission time was significantly reduced in the HCQ treatment group. The authors do not provide the data they measured for this outcome. Perhaps the treated group had more patients on steroids or inhalers.
Because the allocation of the other medications is not given and the authors did not anywhere indicate that other medications were equally distributed between the arms, it is not certain from the results presented whether the HCQ was the only variable between the arms. I believe, you don't, that my presentation of the findings was fair.

A new study just reported, you can start a thread if you like as I'll not be doing it today

https://www.medrxiv.org/content/10.1101/2020.04.10.20060558v1.full.pdf

[rmd2]

And what does that prove to you? Science is not advanced by anecdotes. Over 80 patients took it in the above study without benefit. The evidence is still murky. It may help - it may hurt it - may do nothing. The important part of a negative report it that it disproves the claim that HCQ is a miracle that will benefit a large percentage of the ill people who receive it. That part is clearly wrong in the patient population studied. If it helps some, that evidence is not yet established or disproven.

Wrong. Science often advances first from anecdotal evidence. Often medical and scientific advances are found after information comes in about something unexpected that is working for a problem. It can be a complete surprise but it works! Afterward it can be put into testing and proof. History abounds with this type of advancement.

[graciegirl]

I am not saying that HCQ with or without other therapeutics is of benefit or not. I am just reporting every study I can find.

This is from France. They looked back at the records from 4 hospitals of all patients who were ill enough to be admitted and required oxygen help, but not ICU ill at the time of admission. Then they analyzed the hospital course comparing those who did vs did not get HCQ. The patients were not randomized but the authors used the records to check whether the treated vs the untreated patients differed on admission in several ways.

Interestingly "All comorbidities were less frequent in the HCQ group." This would mean that the likelihood of progressing to severe illness would theoretically be higher in the NOT treated group as they had more comorbidities. The differences were trends, not significantly different.

84 patients received HCQ, 97 did not receive HCQ.


None of these are significant differences. See the article for full statistical analysis.

This study showed no benefit on any of the measures examined. This is limited to patients admitted with an oxygen requirement but not ICU ill on admission.

You can read the details HERE (https://www.medrxiv.org/content/10.1101/2020.04.10.20060699v1.full.pdf). Note this is pre-publication and not yet peer reviewed.

Doctor,

Have you heard about a "positional" therapy for people with pneumonia that has them placed on their stomach? I heard the tale end of this discussed and I don't know whether it is ever used or not and wonder how it would help. I can't find much when I google and there are so many wild ideas floating around about treatments for Covid-19. I thought I would ask an expert.

[blueash]

Doctor,

Have you heard about a "positional" therapy for people with pneumonia that has them placed on their stomach? I heard the tale end of this discussed and I don't know whether it is ever used or not and wonder how it would help. I can't find much when I google and there are so many wild ideas floating around about treatments for Covid-19. I thought I would ask an expert.

The positional information relates mostly to studies that have been done to examine whether patients do better on their back [supine] or on their belly [prone]. The evidence in patients with ARDS [acute respiratory distress syndrome which is the lung failure from Covid pneumonia and other causes] is that they do better on the belly.

If you go to the middle of this document (https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/treatment-guidance-for-critically-ill-patients-with-COVID-19.pdf) from Mass General you can see the recommendation
And HERE (https://emcrit.org/wp-content/uploads/2020/04/2020-04-12-Guidance-for-conscious-proning.pdf) is the statement from the Intensive Care Society which has many references and the explanation of the mechanical and physiologic advantages of being place on the belly in ARDS.

[B767drvr]

Wow, just keep shaking my head at this one! I get blueash...he's a research, fact-based, by the book professional and we're fortunate to have his insight. But, I'm watching video after video of doctors ON THE FRONT LINE saying there's NO approved therapy or cure so they're left to try to figure out the best therapy while their patients die. Hmmm, I truly believe if Trump touted tap water as beneficial, many would line up to call him crazy, urging an unproven, even dangerous (if too much consumed) therapy with unproven side-effects!

How about we let the doctors IN THE TRENCHES decide the best therapy until the study results are known. I cannot help but think the P-word has unfortunately reared its head in the utilization of the drug. Until then... my gut will always favor the THOUSANDS of doctors in the hundreds of ER's using this drug until a therapy is proven and established.

[Mikeod]

Wow, just keep shaking my head at this one! I get blueash...he's a research, fact-based, by the book professional and we're fortunate to have his insight. But, I'm watching video after video of doctors ON THE FRONT LINE saying there's NO approved therapy or cure so they're left to try to figure out the best therapy while their patients die. Hmmm, I truly believe if Trump touted tap water as beneficial, many would line up to call him crazy, urging an unproven, even dangerous (if too much consumed) therapy with unproven side-effects!

How about we let the doctors IN THE TRENCHES decide the best therapy until the study results are known. I cannot help but think the P-word has unfortunately reared its head in the utilization of the drug. Until then... my gut will always favor the THOUSANDS of doctors in the hundreds of ER's using this drug until a therapy is proven and established.

I don’t think he is discouraging use of hydroxychloroquine but is discouraging promotion of it as an established therapy. While there is a suggestion it may be effective, we don’t yet know enough about the disease to determine how much effect it has vs. the normal course for that particular patient. Were they going to recover without the medication anyway? Were they going to succumb even with it? Much more information under much better controls is necessary to determine if this truly an effective therapy.

[vmcoll326]

Just another opinion.
We have too many opinions already!!

[blueash]

Wow, just keep shaking my head at this one! I get blueash...he's a research, fact-based, by the book professional and we're fortunate to have his insight. But, I'm watching video after video of doctors ON THE FRONT LINE saying there's NO approved therapy or cure so they're left to try to figure out the best therapy while their patients die. Hmmm, I truly believe if Trump touted tap water as beneficial, many would line up to call him crazy, urging an unproven, even dangerous (if too much consumed) therapy with unproven side-effects!

How about we let the doctors IN THE TRENCHES decide the best therapy until the study results are known. I cannot help but think the P-word has unfortunately reared its head in the utilization of the drug. Until then... my gut will always favor the THOUSANDS of doctors in the hundreds of ER's using this drug until a therapy is proven and established.

Mikeod seems to understand my posts. This has no relationship to Trump as a politician. It does relate to his promotion of an unproven therapy as if it were proven. He is not a scientist and has admitted he makes decisions on the basis of gut feelings as do you. That is perhaps appropriate in picking your friends, your cabinet, and what to buy for dinner. It is not fine for picking what drugs are best for particular illnesses.

I'll say it again... I do not oppose doctors trying desperate measures when there are no proven measures. If I were still practicing I might very well provide HCQ to my COVID patients.. but I'd be closely following the literature to see whether its use is being supported or refuted by properly conducted studies. It used to be a tongue in cheek comment when dealing with dying patients where you'd run out of options that "No patient should die without the benefit of steroids", and you'd order steroids.

The doctors in the trenches are not supplying the best therapy, they are supplying the therapy promoted by the POTUS outside of his area of any genius. Nobody knows yet if it is the best therapy; perhaps it is actually harmful without benefit. Your jump to using "best therapy" shows how the POTUS has influenced what should be a scientific analysis.

From a study in China (https://www.medrxiv.org/content/10.1101/2020.04.10.20060558v1.full.pdf):
"HCQ was also recently recommended by the American president Donald Trump. Such a presidential endorsement stimulates an avalanche of demand for HCQ, which buried the dark-side of this drug"

They put that comment in a research study. He should not be influencing medical practice. He is, even in China.

I will, until I burn out on it, continue to post studies on HCQ as I find them. I hope a controlled study establishes HCQ clinically helps patients. So far the evidence for benefit has not been presented.

Thank you for "he's a research, fact-based, by the book professional " I encourage you to find doctors who continue after medical school, to read the research and adjust their therapies based on facts, not gut feelings.

[GoodLife]

The doctors in the trenches are not supplying the best therapy, they are supplying the therapy promoted by the POTUS outside of his area of any genius.

LOL So the 1000s of Doctors all over the world are not using HCQ because they might have studied reports, talked to fellow Doctors treating the virus and seen enough to convince them to use it. Nope, they are all blindly following Trump.

Personally, I am going to listen to Doctors actually treating the disease and follow what they are doing.

[blueash]

Originally Posted by blueash
Science is not advanced by anecdotes.

Wrong. Science often advances first from anecdotal evidence. Often medical and scientific advances are found after information comes in about something unexpected that is working for a problem. It can be a complete surprise but it works! Afterward it can be put into testing and proof. History abounds with this type of advancement.

This is a misunderstanding of my meaning. I should have been clearer. Of course observation or serendipity provides a spark toward understanding and proof. Anecdotes provide clues to construct a hypothesis. Then you test that hypothesis to see if the evidence supports or refutes your premise. Only after you do the testing do you have science.
So what I meant by science is not advanced by anecdotes is that science is advanced by testing, retesting, and validation. While it is an anecdote it is just a guess.

[blueash]

Personally, I am going to listen to Doctors actually treating the disease and follow what they are doing.

Yes, I encourage that. I am posting lots of research being done by Doctors actually treating the disease. The studies the Doctors produce are from treating real patients with real protocols looking for the presence or absence of real results from real drugs. It is being done by Doctors. Medicine is full of sad stories of doctors providing care in a non-proven manner only to have proper studies prove the fallacy or even danger of that care. When I practiced I sought to provide evidence based care. Often what everyone else is doing is good care and seems reasonable. Sometimes it is not. In those cases I'd like to know if I should be doing something different.

Here's an example. In caring for premature newborns, premies, the major killer was immature lungs thus inadequate oxygen being provided. Once the ability to place premies into incubators and increase the oxygen being delivered to them became available it was rapidly adopted and saved lives. As there was no good way to figure out how much extra oxygen to give, better to give too much than too little. Oxygen is good.

That was how everyone did it, and it was wrong. Only scientific studies and long term follow-up proved what everybody was doing had risk greater than benefit. Now the amount of oxygen is carefully controlled to avoid excess oxygen [it's dangerous].

Sometimes experience is just the repetition of the same mistake.