[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. Note this is pre-publication and not yet peer reviewed.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"Caution: Preprints are preliminary reports of work that have not been certified by peer review.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/10.1...758v2.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]

Originally Posted by 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.

https://www.medrxiv.org/content/10.1...758v2.full.pdf

Nice try, didn't miss it

New study on Hydroxychloroquine with Azithromycin, failure

I specifically noted this positive study

Thanks for playing

[JP]

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

[blueash]

Originally Posted by 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...

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]

Originally Posted by JP

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]

Originally Posted by blueash

Nice try, didn't miss it

New study on Hydroxychloroquine with Azithromycin, failure

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]

Originally Posted by 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.


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. 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]

Originally Posted by JP

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

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

[Annie66]

Originally Posted by 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."

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.