5 ms·

To those who aren't aware of it, there was a recently completed (small) clinical study of hydroxychloroquine (and in some cases HCQ plus z-pack) just completed

by blhack 7y ago

To those who aren't aware of it, there was a recently completed (small) clinical study of hydroxychloroquine (and in some cases HCQ plus z-pack) just completed in France. The results are here: https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf https://www.mediterranee-infection.com/wp-content/uploads/20... They're miraculous. This is a well-studied, mass-produced drug which has been around for 70 years and appears to be highly effective at treating this virus.

sunseb 7y ago
[Message deleted because I agree I cannot backup my claim and I may be wrong.]
- habosa 7y ago
  Can you explain more about this?
- bsaul 7y ago
  Yeah, you’ll need some serious source to backup this claim. Having a deal with a lab from the same country, that produces a drug you’ve been studying for decades in your lab and hospital isn’t something that justifies dumping on someone’s reputation. Especially if the person in question looks like he has enough papers published to justify his claims. Ps: i do agree that his tone and style looks unorthodox. But results is the only thing we should care about.
cycrutchfield 7y ago
>They're miraculous. Where are you seeing that? Because what I see is a very non-rigorous, non-randomized study. Also, what about this part: >A total of 26 patients received hydroxychloroquine and 16 were control patients. Six hydroxychloroquine-treated patients were lost in follow-up during the survey because of early cessation of treatment. Reasons are as follows: three patients were transferred to intensive care unit, including one transferred on day2 post-inclusion who was PCR-positive on day1, one transferred on day3 post-inclusion who was PCR-positive on days1-2 and one transferred on day4 post-inclusion who was PCRpositive on day1 and day3; one patient died on day3 post inclusion and was PCR-negative on day2; one patient decided to leave the hospital on day3 post-inclusion and was PCR-negative on days1-2; finally, one patient stopped the treatment on day3 post-inclusion because of nausea and was PCR-positive on days1-2-3. Really easy to have "miraculous" results when 20+% of your treatment group were excluded and also happened to be the ones with the most severe symptoms.
- prostheticvamp 7y ago
  Medical doctor and statistician weighing in just to say: I agree fully with what you wrote. No miracles observed.
  - blhack 7y ago
    I don't mean and disrespect to you as a physician, but there appear to be many experts who disagree with you to the point of acting out their disagreement at scale. Chloroquine has become a standard part of treatment for this disease in several countries, and its continued use seems to imply its efficacy.
    - endtime 7y ago
      I don't think he said no one is using (or should use) it, just that the results aren't "miraculous".
    - SpikeDad 7y ago
      Haha. Continued use seems to imply it's efficacy. This might be the most illogical post on Hacker News in some time. I think we could have a whole website of things that were continued to be used without a shred of evidence of effectiveness.
      - prostheticvamp 7y ago
        We could also have a whole website of things people strongly believed were effective that RCTs absolutely demolished.
        SpikeDad 7y ago
        RCT? Sorry don't know that abbreviation.
        jshevek 7y ago
        Randomized controlled trial
tanilama 7y ago
Worth mentioning that, with China/Korea, now France deploys this drug to frontlines, in the best case scenario, which is the South Korea case, the death rate still sets at 1%, so still 10 times more lethal than flu. We all want a miracle, but we need to be cautious about it. I am more curious right now as whether this drug can work as a preventative medication for high risk individual to lower the chance for getting infected, TBH. That will help the medical stuff greatly.
- pombrand 7y ago
  South Korea is at 0.6% CFR, the true IFR will be lower than this again due to false negatives and biased testing against symptomatic people. South Korea will max end up with a IFR of 0.2-0.5%, 2 to 5 times worse than the flu.
snowwrestler 7y ago
To those who aren't aware of it, the reason someone thought to try this is that this type of drug has shown intermittent promise in treating viral infections for years. But to date it has never really panned out in clinical trials. (If it had, we would all be taking chloroquine every time we caught a serious virus like the flu). Doesn't mean it can't be beneficial this time for this particular virus; we should always keep trying. I'm just saying it's probably a bit early to be calling miracles based on one small study.
- paulmd 7y ago
  > To those who aren't aware of it, the reason someone thought to try this is that this type of drug has shown intermittent promise in treating viral infections for years. No, the actual reason is that Chinese doctors noted a statistical abberation in their coronavirus patients: none of the patients had lupus. They called around and confirmed it, none of the hospitals had any patients with lupus. And the standard chinese treatment for lupus is... chloroquine. https://www.jqknews.com/news/388543-The_novel_coronavirus_pneumonia_has_short_term_curative_effect_on_the_treatment_of_new_crown_pneumonia.html https://www.jqknews.com/news/388543-The_novel_coronavirus_pn... Chloroquine has proceeded from statistical anomaly, to successful case studies, to successful non-random trials, and now is in random trials. I'm not a doctor but I think there's a pretty good chance it'll be effective. Yes, it is not officially approved yet, but it is being deployed in China, Korea, and other countries off-label. Right now there are no other options. I'd take chloroquine over nothing. Overall it is not pleasant but there are few dangerous side effects in the short term (retinopathy is a possible side effect if duration of treatment is on the order of months to years). It is an over-the-counter medication in a lot of the world, it is behind the counter in a lot of other places (including the UK). (the US just likes making sure doctors get paid even if a medication is quite safe. There are a lot of medications like oral contraceptives that are routinely done over-the-counter in most other places that we insist are so wildly dangerous you couldn't begin and discontinue them if you noticed side effects. And on the flip side, there's lots of drugs like tylenol that we know to be horribly unsafe and yet they remain OTC anyway, or even in "abuse resistant" combination products. Chloroquine is a pretty standard antimalarial and places that have malaria don't think it's a big enough deal that you need a doctor to get it.) Given the lack of other options, given the known nature of the drug, if I was in a hospital dying of COVID would I want to give it a shot? Yes. Same principle as experimental cancer drugs. Some chance is better than no chance. Anyone we can treat with pharmaceutical interventions instead of ventilators frees up those ventilators for more critical patients. Even if they still have to remain under some degree of medical supervision, it frees up ICU beds.
Mvandenbergh 7y ago
This is not a rigorous study and doesn't pretend to be but those are sufficiently impressive results that it is still a cause for hope. You need meticulous study design when you're looking for small effect sizes, with a large enough effect you can extract useful information even from flawed data.

by blhack 7y ago

sunseb 7y ago

[Message deleted because I agree I cannot backup my claim and I may be wrong.]

habosa 7y ago
Can you explain more about this?
bsaul 7y ago
Yeah, you’ll need some serious source to backup this claim. Having a deal with a lab from the same country, that produces a drug you’ve been studying for decades in your lab and hospital isn’t something that justifies dumping on someone’s reputation. Especially if the person in question looks like he has enough papers published to justify his claims. Ps: i do agree that his tone and style looks unorthodox. But results is the only thing we should care about.

cycrutchfield 7y ago

>They're miraculous. Where are you seeing that? Because what I see is a very non-rigorous, non-randomized study. Also, what about this part: >A total of 26 patients received hydroxychloroquine and 16 were control patients. Six hydroxychloroquine-treated patients were lost in follow-up during the survey because of early cessation of treatment. Reasons are as follows: three patients were transferred to intensive care unit, including one transferred on day2 post-inclusion who was PCR-positive on day1, one transferred on day3 post-inclusion who was PCR-positive on days1-2 and one transferred on day4 post-inclusion who was PCRpositive on day1 and day3; one patient died on day3 post inclusion and was PCR-negative on day2; one patient decided to leave the hospital on day3 post-inclusion and was PCR-negative on days1-2; finally, one patient stopped the treatment on day3 post-inclusion because of nausea and was PCR-positive on days1-2-3. Really easy to have "miraculous" results when 20+% of your treatment group were excluded and also happened to be the ones with the most severe symptoms.

prostheticvamp 7y ago
Medical doctor and statistician weighing in just to say: I agree fully with what you wrote. No miracles observed.
- blhack 7y ago
  I don't mean and disrespect to you as a physician, but there appear to be many experts who disagree with you to the point of acting out their disagreement at scale. Chloroquine has become a standard part of treatment for this disease in several countries, and its continued use seems to imply its efficacy.
  - endtime 7y ago
    I don't think he said no one is using (or should use) it, just that the results aren't "miraculous".
  - SpikeDad 7y ago
    Haha. Continued use seems to imply it's efficacy. This might be the most illogical post on Hacker News in some time. I think we could have a whole website of things that were continued to be used without a shred of evidence of effectiveness.
    - prostheticvamp 7y ago
      We could also have a whole website of things people strongly believed were effective that RCTs absolutely demolished.
      - SpikeDad 7y ago
        RCT? Sorry don't know that abbreviation.
        jshevek 7y ago
        Randomized controlled trial

tanilama 7y ago

Worth mentioning that, with China/Korea, now France deploys this drug to frontlines, in the best case scenario, which is the South Korea case, the death rate still sets at 1%, so still 10 times more lethal than flu. We all want a miracle, but we need to be cautious about it. I am more curious right now as whether this drug can work as a preventative medication for high risk individual to lower the chance for getting infected, TBH. That will help the medical stuff greatly.

pombrand 7y ago
South Korea is at 0.6% CFR, the true IFR will be lower than this again due to false negatives and biased testing against symptomatic people. South Korea will max end up with a IFR of 0.2-0.5%, 2 to 5 times worse than the flu.

snowwrestler 7y ago

To those who aren't aware of it, the reason someone thought to try this is that this type of drug has shown intermittent promise in treating viral infections for years. But to date it has never really panned out in clinical trials. (If it had, we would all be taking chloroquine every time we caught a serious virus like the flu). Doesn't mean it can't be beneficial this time for this particular virus; we should always keep trying. I'm just saying it's probably a bit early to be calling miracles based on one small study.

paulmd 7y ago
> To those who aren't aware of it, the reason someone thought to try this is that this type of drug has shown intermittent promise in treating viral infections for years. No, the actual reason is that Chinese doctors noted a statistical abberation in their coronavirus patients: none of the patients had lupus. They called around and confirmed it, none of the hospitals had any patients with lupus. And the standard chinese treatment for lupus is... chloroquine. https://www.jqknews.com/news/388543-The_novel_coronavirus_pneumonia_has_short_term_curative_effect_on_the_treatment_of_new_crown_pneumonia.html https://www.jqknews.com/news/388543-The_novel_coronavirus_pn... Chloroquine has proceeded from statistical anomaly, to successful case studies, to successful non-random trials, and now is in random trials. I'm not a doctor but I think there's a pretty good chance it'll be effective. Yes, it is not officially approved yet, but it is being deployed in China, Korea, and other countries off-label. Right now there are no other options. I'd take chloroquine over nothing. Overall it is not pleasant but there are few dangerous side effects in the short term (retinopathy is a possible side effect if duration of treatment is on the order of months to years). It is an over-the-counter medication in a lot of the world, it is behind the counter in a lot of other places (including the UK). (the US just likes making sure doctors get paid even if a medication is quite safe. There are a lot of medications like oral contraceptives that are routinely done over-the-counter in most other places that we insist are so wildly dangerous you couldn't begin and discontinue them if you noticed side effects. And on the flip side, there's lots of drugs like tylenol that we know to be horribly unsafe and yet they remain OTC anyway, or even in "abuse resistant" combination products. Chloroquine is a pretty standard antimalarial and places that have malaria don't think it's a big enough deal that you need a doctor to get it.) Given the lack of other options, given the known nature of the drug, if I was in a hospital dying of COVID would I want to give it a shot? Yes. Same principle as experimental cancer drugs. Some chance is better than no chance. Anyone we can treat with pharmaceutical interventions instead of ventilators frees up those ventilators for more critical patients. Even if they still have to remain under some degree of medical supervision, it frees up ICU beds.

Mvandenbergh 7y ago

This is not a rigorous study and doesn't pretend to be but those are sufficiently impressive results that it is still a cause for hope. You need meticulous study design when you're looking for small effect sizes, with a large enough effect you can extract useful information even from flawed data.