[blueash]

There have been many threads pushing hydroxychloroquine with and without azithromycin. This combination has been touted by many here and by some elsewhere as having been proven. I have participated in the TOTV threads cautioning that the data are not clear and more studies are being done.

One is now ready for publication. Like the one that started it all, this is from France. It looked at 11 patients in Paris to attempt to replicate the earlier study where it was claimed that 6 of 6 patients given the combination had no virus detected after 6 days from the start of therapy. Exactly the same drugs and doses were used.

At the time of treatment initiation, 10/11 had fever and received nasal oxygen therapy. Within 5 days, one patient died, two were transferred to the ICU. In one patient, hydroxychloroquine and azithromycin were discontinued after 4 days because of a prolongation of the QT interval from 405 ms before treatment to 460 and 470 ms under the combination. Mean through blood concentration of hydroxychloroquine was 678 ng/mL (range: 381-891) at days 3-7 after treatment initiation.
Repeated nasopharyngeal swabs in 10 patients (not done in the patient who died) using a qualitative PCR assay.. were still positive for SARS-CoV2 RNA in 8/10 patients (80%, 95% confidence interval: 49-94) at days 5 to 6 after treatment initiation.

Keep in mind that in the early study 12% of non-treated patients cleared their virus. Here 20% of treated cleared and 80% failed.

The authors' conclusion:

In summary, despite a reported antiviral activity of chloroquine against COVID-19 in vitro, we found no evidence of a strong antiviral activity or clinical benefit of the combination of hydroxychloroquine and azithromycin for the treatment of our hospitalized patients with severe COVID-19.

This is how science works. Someone tests a hypothesis and makes their results public. Others then attempt to replicate those findings. After enough different scientists have tested the suggestion a consensus will be reached if the data holds up to scrutiny. It is too early to know which way this is going to go, but 100% efficacy as was claimed now seems in doubt, unfortunately.

Also note that 1 of 11 had to have the medication stopped because of unexpected cardiac changes putting him or her at risk for sudden death after just a few doses. These medications are not without risk.

[chet2020]

Good review, thank you.

[manaboutown]

The COVID-19 Pandemic: Brand New Research on Hydroxychloroquine Shows More Positive Signs It Could Be a Treatment for COVID-19 | The Dr. Oz Show

[graciegirl]

Eleven patients does not make for a large study to prove or disprove anything and I am sure that is the point you are making.

We all are clutching at straws. Hoping for a vaccine sooner than predicted. Stay safe, Doctor. I like to debate you on politics but highly respect your medical experience and knowledge.

[skyking]

I like Dr Oz.

I assume if BlueAsh gets the virus he will refuse the Hydroxychloroquine.

If I get it I will welcome anything that won't kill me.

[blueash]

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.

Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial | medRxiv

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.

But for Time to clinical recovery, the body temperature recovery time and the cough remission time were significantly shortened in the HCQ treatment group. Besides, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 32) compared with the control group (54.8%, 17 of 32). Notably, all 4 patients progressed to severe illness that occurred in the control group. However, there were 2 patients with mild adverse reactions in the HCQ treatment group

All the patients received what the article calls standard therapy

all received the standard treatment (oxygen therapy, antiviral agents, antibacterial agents, and immunoglobulin, with or without corticosteroids), patients in the HCQ treatment group received additional oral HCQ (hydroxychloroquine sulfate tablets, Shanghai Pharma) 400 mg/d (200 mg/bid) between days 1 and 5

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.

Also note that the only statistically significant benefit was in time to decrease fever and cough. The difference in chest findings tended to favor HCQ but was not statistically significant.

As to the personal attacks at me for actually posting the studies and their findings. I have posted every single one I have found, both those that show benefit and those that failed. It is about 50/50 at this time. It you already have your mind made up you have my permission to stop reading my posts about the studies. I don't have my mind made up because the data is not clear and the science is not established. Some people have open and inquisitive minds and are amenable to change based on evidence. Some people don't.

[blueash]

Originally Posted by graciegirl

Eleven patients does not make for a large study to prove or disprove anything and I am sure that is the point you are making.

We all are clutching at straws. Hoping for a vaccine sooner than predicted. Stay safe, Doctor. I like to debate you on politics but highly respect your medical experience and knowledge.

Exactly correct. This is a small study that attempted to replicate a very specific finding from another study.. That HCQ and Zithromax combined was 100% effective in making patients culture/PCR negative. This study failed to replicate that finding and in fact failed to show any benefit at reducing that specific goal, making the patient virus negative.

And as you are a reliable reader I'll digress here to explain culture vs. PCR. In the cultures done in the French studies, a sample is taken then incubated with live cells. If there is virus present those cells are disrupted and this alteration is visually confirmed by microscope. In pcr testing the presence of the RNA [like DNA] known to exist in the virus is measured. PCR is what the labs are using in large scale testing. This distinction is potentially important. A viral culture proves that the virus is still active and capable of attacking cells. While a virus is not "alive" that is a reasonable analogy. On the other hand, a positive PCR could occur if inactive viral particles are present which still have RNA intact but are no longer capable of causing disease. There are animal and human studies showing that the PCR stays positive after the culture becomes negative in other corona virus diseases. You can read about them in the Lancet

In a ferret model of H1N1 infection, the loss of viral culture positivity but not the absence of viral RNA coincided with the end of the infectious period. In fact, real-time reverse transcriptase PCR results remained positive 6–8 days after the loss of transmissibility. For SARS coronavirus, viral RNA is detectable in the respiratory secretions and stools of some patients after onset of illness for more than 1 month, but live virus could not be detected by culture after week 3

But because viral cultures are very difficult to do, using PCR is standard. You have certainly read reports of Covid being found in stool samples after clinical recovery. Those are AFAIK all PCR findings.

[bumpygreens]

blueish, thanks for the posts. Ignore the personal attacks. We already know the outcome of assuming.

[blueash]

Originally Posted by bumpygreens

blueish, thanks for the posts. Ignore the personal attacks. We already know the outcome of assuming.

Sure enough. Mrs Blueash asks what I'm doing on the laptop. I just tell her "pie fights"

[skyking]

Hydroxychloroquine 'most effective' coronavirus treatment: poll

[CFrance]

Originally Posted by blueash

There have been many threads pushing hydroxychloroquine with and without azithromycin. This combination has been touted by many here and by some elsewhere as having been proven. I have participated in the TOTV threads cautioning that the data are not clear and more studies are being done.

One is now ready for publication. Like the one that started it all, this is from France. It looked at 11 patients in Paris to attempt to replicate the earlier study where it was claimed that 6 of 6 patients given the combination had no virus detected after 6 days from the start of therapy. Exactly the same drugs and doses were used.



Keep in mind that in the early study 12% of non-treated patients cleared their virus. Here 20% of treated cleared and 80% failed.

The authors' conclusion:


This is how science works. Someone tests a hypothesis and makes their results public. Others then attempt to replicate those findings. After enough different scientists have tested the suggestion a consensus will be reached if the data holds up to scrutiny. It is too early to know which way this is going to go, but 100% efficacy as was claimed now seems in doubt, unfortunately.

Also note that 1 of 11 had to have the medication stopped because of unexpected cardiac changes putting him or her at risk for sudden death after just a few doses. These medications are not without risk.

Thanks for the explanation. You are my go-to poster on TOTV for matters medical.

[OrangeBlossomBaby]

Originally Posted by graciegirl

Eleven patients does not make for a large study to prove or disprove anything and I am sure that is the point you are making.

We all are clutching at straws. Hoping for a vaccine sooner than predicted. Stay safe, Doctor. I like to debate you on politics but highly respect your medical experience and knowledge.

11 patients makes for an absolutely guaranteed, solid, confirmed, bonafide, verified, reliable prediction that this cocktail will -not- work 100%, AND that it comes with risk of death (since 1 had to discontinue because the drug was giving him deadly side effect).

When you start with the hypothesis that it's 100% effective, then a single failure to be effective - crumbles that hypothesis and renders it categorically false.

[skyking]

???? Where did anyone say it was 100% effective? Very few medications are.

So you are saying that it is 100% ineffective? That's a false assumption. Also the drug has been around since 1955. Any adverse effects are well known.

[B767drvr]

Originally Posted by OrangeBlossomBaby

11 patients makes for an absolutely guaranteed, solid, confirmed, bonafide, verified, reliable prediction that this cocktail will -not- work 100%, AND that it comes with risk of death (since 1 had to discontinue because the drug was giving him deadly side effect).

When you start with the hypothesis that it's 100% effective, then a single failure to be effective - crumbles that hypothesis and renders it categorically false.

Um... not a scientist... but think you are going to eat crow.

[Villageswimmer]

Originally Posted by CFrance

Thanks for the explanation. You are my go-to poster on TOTV for matters medical.

I agree. Thank you for your professional, unbiased messages. The fact that you take the time to post shows that you care about others.