4 ms·

Only one clinical study has been published on chloroquine (by a French group), and the results are lackluster. No patient was cleared of virus after six days us

by aazaa 7y ago

Only one clinical study has been published on chloroquine (by a French group), and the results are lackluster. No patient was cleared of virus after six days using hydroxychloroquine alone. A tiny fraction of patients were cleared in 4 days using an adjunct therapy (azithromycin). The study itself has issues, and it's not even clear whether it will clear peer review. The President is doing something very dangerous here with his comments in the last two days. By stoking chloroquine hype, he's setting the country up for a massive disappointment should the drug fail to produce treatment, or unexpected side effects. Although the drug has been used in humans for decades to treat malaria, it has not been used to any extent on humans to treat COVID-19. There's a non-zero chance of adverse reactions, potentially serious given known problems with the chloroquines. Even worse, the idea that a "treatment" exists will encourage people to let down their guard and will very likely lead to even worse outbreaks. Unexpected things happen all the time in clinical trials. This is the main reason it costs billions to bring a drug to market. We can't predict jack squat.

Judson 7y ago
Are you referring to this study? https://drive.google.com/file/d/186Bel9RqfsmEx55FDum4xY_IlWSHnGbj/view https://drive.google.com/file/d/186Bel9RqfsmEx55FDum4xY_IlWS... Afaikt, 57% patients on HCQ alone were “virologically cleared” by day 6 and 100% on HCQ+Azithromycin were clear By day 6. Compared with ~12% of control group.
- aazaa 7y ago
  Yes, and I'm looking at the aggregate data in the last two graphs, and also the big table. HCQ + AZ was the only group with clearance for all after six days. It was also the smaller of the two groups, which makes it hard to give any weight to the finding. But there are many other features of this study that make the result hard to interpret.
  - Judson 7y ago
    Great that we’re looking at the same study! I’m not sure what you mean by: “No patient was cleared of virus after six days using hydroxychloroquine alone.“ Because the percentages there are 57% Of patients on HCQ alone we’re cleared, vs 12% control.
    - jschwartzi 7y ago
      Is there sufficient evidence in favor of rejecting the null hypothesis, that 57% of patients in the HCQ study group would have gone on to spontaneously recover without HCQ? Because that's the really interesting question. It's not a question of the study group versus control group, it's a question of whether the study group and control group had enough characteristics in common to make them statistically equivalent samples of a population that vary only in whether they were given HCQ. And I think the consensus among people who are clear on that is that the populations have too little in common.
      - Judson 7y ago
        A fair criticism of the study, but does not make the case that “no patient on HCQ alone was virus free by day 6”, since that is objectively false by my reading.
capableweb 7y ago
> Although the drug has been used in humans for decades to treat malaria, it has not been used to any extent on humans to treat COVID-19 This isn't very weird, is it? Most people didn't start to hear about COVID-19 until January this year and many others didn't start hearing about it until people got infected in their countries. As with everything with clinical trials, even if it seems to be helping, it'll take many months before it'll be prescribed to people for treating COVID-19
- aazaa 7y ago
  Chloroquine (not AFAIK hydroxychloroquine) has been made available to doctors (and therefore patients) through "Compassionate Use." This means that doctors can prescribe chloroquine to patients before and outside of a clinical trial. I suspect many will take the chance. In effect, the US will be conducting a large-scale, semi-controlled clinical study on a drug with a significant side effect profile in the midst of the worst pandemic in 100 years.
m0zg 7y ago
> The President is doing something very dangerous And if he didn't do what he did, you'd be saying the same thing once hundreds of people start dying per day because there's not enough chloroquine available. How do you know it's "hype"? Because orange man bad? It has shown effectiveness against SARS previously. It's been available for 50+ years and doctors are familiar with its side effects and safety profile. The Chinese list it in their official treatment guidelines right next to antivirals. It's also being used in France and Italy. Sure, the study produced in the last 2 weeks in France was not very rigorous, but it's not the only evidence of efficacy. Could you quarantine your partisanship for a while? Maybe order it to shelter in place until, say, July?
- aazaa 7y ago
  I would say the same thing regardless of the man on the podium. You're the one bringing partisanship into this. It's hype because nothing has been demonstrated yet using practices that have been worked out through a hundred years of painful trial and error. It's hype because he's saying he thinks it will work when he has no data to support that conclusion. It's hype because as the president must surely be aware, Americans are scared right now, and with good reason. To continue to double down on a "feel" in the current environment is hype. The study from France, with its many flaws, is the only one that has been published. The "guidance" from the Chinese authorities is suspect to say the least.
  - m0zg 7y ago
    > I would say the same thing regardless of the man on the podium. Must have been hard for you to stomach 2009 then when 60 million Americans got infected with H1N1, nothing whatsoever was done, and the CDC budget was cut the very next year.
    - rbanffy 7y ago
      We didn't have to stomach much. https://www.propublica.org/article/no-president-trump-the-coronavirus-is-nothing-like-h1n1-swine-flu-either https://www.propublica.org/article/no-president-trump-the-co...
cm2187 7y ago
It only needs to reduce the viral load significantly to become a better alternative to killing the economy with a lockdown.

by aazaa 7y ago

Judson 7y ago

Are you referring to this study? https://drive.google.com/file/d/186Bel9RqfsmEx55FDum4xY_IlWSHnGbj/view https://drive.google.com/file/d/186Bel9RqfsmEx55FDum4xY_IlWS... Afaikt, 57% patients on HCQ alone were “virologically cleared” by day 6 and 100% on HCQ+Azithromycin were clear By day 6. Compared with ~12% of control group.

aazaa 7y ago
Yes, and I'm looking at the aggregate data in the last two graphs, and also the big table. HCQ + AZ was the only group with clearance for all after six days. It was also the smaller of the two groups, which makes it hard to give any weight to the finding. But there are many other features of this study that make the result hard to interpret.
- Judson 7y ago
  Great that we’re looking at the same study! I’m not sure what you mean by: “No patient was cleared of virus after six days using hydroxychloroquine alone.“ Because the percentages there are 57% Of patients on HCQ alone we’re cleared, vs 12% control.
  - jschwartzi 7y ago
    Is there sufficient evidence in favor of rejecting the null hypothesis, that 57% of patients in the HCQ study group would have gone on to spontaneously recover without HCQ? Because that's the really interesting question. It's not a question of the study group versus control group, it's a question of whether the study group and control group had enough characteristics in common to make them statistically equivalent samples of a population that vary only in whether they were given HCQ. And I think the consensus among people who are clear on that is that the populations have too little in common.
    - Judson 7y ago
      A fair criticism of the study, but does not make the case that “no patient on HCQ alone was virus free by day 6”, since that is objectively false by my reading.

capableweb 7y ago

> Although the drug has been used in humans for decades to treat malaria, it has not been used to any extent on humans to treat COVID-19 This isn't very weird, is it? Most people didn't start to hear about COVID-19 until January this year and many others didn't start hearing about it until people got infected in their countries. As with everything with clinical trials, even if it seems to be helping, it'll take many months before it'll be prescribed to people for treating COVID-19

aazaa 7y ago
Chloroquine (not AFAIK hydroxychloroquine) has been made available to doctors (and therefore patients) through "Compassionate Use." This means that doctors can prescribe chloroquine to patients before and outside of a clinical trial. I suspect many will take the chance. In effect, the US will be conducting a large-scale, semi-controlled clinical study on a drug with a significant side effect profile in the midst of the worst pandemic in 100 years.

m0zg 7y ago

> The President is doing something very dangerous And if he didn't do what he did, you'd be saying the same thing once hundreds of people start dying per day because there's not enough chloroquine available. How do you know it's "hype"? Because orange man bad? It has shown effectiveness against SARS previously. It's been available for 50+ years and doctors are familiar with its side effects and safety profile. The Chinese list it in their official treatment guidelines right next to antivirals. It's also being used in France and Italy. Sure, the study produced in the last 2 weeks in France was not very rigorous, but it's not the only evidence of efficacy. Could you quarantine your partisanship for a while? Maybe order it to shelter in place until, say, July?

aazaa 7y ago
I would say the same thing regardless of the man on the podium. You're the one bringing partisanship into this. It's hype because nothing has been demonstrated yet using practices that have been worked out through a hundred years of painful trial and error. It's hype because he's saying he thinks it will work when he has no data to support that conclusion. It's hype because as the president must surely be aware, Americans are scared right now, and with good reason. To continue to double down on a "feel" in the current environment is hype. The study from France, with its many flaws, is the only one that has been published. The "guidance" from the Chinese authorities is suspect to say the least.
- m0zg 7y ago
  > I would say the same thing regardless of the man on the podium. Must have been hard for you to stomach 2009 then when 60 million Americans got infected with H1N1, nothing whatsoever was done, and the CDC budget was cut the very next year.
  - rbanffy 7y ago
    We didn't have to stomach much. https://www.propublica.org/article/no-president-trump-the-coronavirus-is-nothing-like-h1n1-swine-flu-either https://www.propublica.org/article/no-president-trump-the-co...

cm2187 7y ago

It only needs to reduce the viral load significantly to become a better alternative to killing the economy with a lockdown.