3 ms·

Hydroxychloroquine associated with less mortality in critical Covid-19 patients

14 points by drocer88 7y ago

joshstrange 7y ago
Interesting, I'm bullish on Hydroxychloroquine (not because of any political reasons) but everything I've seen on it working has to do with using it as early as possible (so as close as the onset of symptoms). This study appears to have only administered it to critically ill patients which I would expect to have less of an effect. That said I'm not going to be mad that it appears to have worked for the critically ill (something I have not seen anywhere else really). However, this NOT a randomized-double blind, they say at the end they still need to do one of those to be sure but a fatality rate of 18.8% (with HCQ) vs 45.8& (without) and a p<0.001 is very good news if proven true. Remember this is a pre-print, NOT peer reviewed. It's interesting that we aren't seeing very many studies done with early HCQ dosing. Antivirals like Tamiflu (for the flu) only really help if administer very close to the start of symptoms showing up. We have seen a few Remdesivir that specifically break out when the onset of symptoms was, I wonder why we haven't seen the same for HCQ? Could it be the price difference between HCQ and Remdesivir?
- nrr 7y ago
  (Disclaimer: I'm not a medical professional, and I don't lay any claim to being authoritative. This is mostly anecdotal.) I suspect the difference in HCQ and remdesivir dosing studies mostly has to do with the classes of drugs those are. One's an antimalarial, and the other's an antiviral. There might be more of a priority to explore what existing antivirals could have an effect. There could also be a sheepishness in wanting to conduct those studies with HCQ given that we still largely don't understand how it works. That said, apropos HCQ being associated with less mortality in advanced cases: As an antimalarial, it has some interesting immunosuppressive properties. Notably, it's used as a treatment for lupus in order to temper or moderate the kind of immune responses seen in those patients. I imagine that there's possibly some sort of (fatal if left untended) immune response that manifests in advanced COVID-19 that HCQ happens to keep down. Writing as an asthmatic who's had his fair share of IV antibiotics to deal with some truly gnarly bouts of pneumonia, acute respiratory distress syndrome is no joke. Any little bit to keep folks off ventilators is truly helpful.
  - joshstrange 7y ago
    > There could also be a sheepishness in wanting to conduct those studies with HCQ given that we still largely don't understand how it works. How it works in what way? We have been using it since 1955 and people take it regularly. The risks are largely known. Remdesivir, on the other hand, is just over a decade old and is a drug in search of a problem (it was not useful in treating Ebola and I can't find any reference to it being used for other treatments). Maybe I should say it's an R&D budget in search of recouping the cost. Look, I don't hate Gilead, in fact they make drugs to both treat and preventive HIV/AIDS. The latter being something I've taken before. But something about this all stinks.
    - giardini 6y ago
      joshstrange says>"We have been using it since 1955 and people take it regularly. The risks are largely known."< This. Actually "we" (the Western World) have been using it [quinine and variants] since the 17th century! And it is a fascinating story of political and medical intrigue and skill. Without quinine derived from the bark of the Peruvian cinchona tree, the British, Dutch et al could not have built their empires in malaria-infested regions of the world: "The global history of quinine, the world’s first anti-malaria drug": https://medium.com/@tcassauwers/the-global-history-of-the-world-s-first-anti-malaria-drug-d1e11f0ba729 https://medium.com/@tcassauwers/the-global-history-of-the-wo... There's are many books that discuss this history, among them: "The Miraculous Fever-Tree: Malaria, Medicine and the Cure that Changed the World" by Fiammetta Rocco https://www.amazon.com/Miraculous-Fever-Tree-Malaria-Medicine-Changed-ebook/dp/B0084WVECE https://www.amazon.com/Miraculous-Fever-Tree-Malaria-Medicin... "The Fever: How Malaria Has Ruled Humankind for 500,000 Years" by Sonia Shaw https://www.amazon.com/Fever-Malaria-Ruled-Humankind-Years-ebook/dp/B003R0LBT4 https://www.amazon.com/Fever-Malaria-Ruled-Humankind-Years-e... There was apparently as much anguish between rival groups (Roman Catholics vs. reformists) about cinchona bark (from which quinine was first extracted) in days gone by as there is today between Democrats and Republicans on the use of quinine's descendents, the sythetic drugs known as (hydroxy)chloroquines. It has been said that Oliver Cromwell's death of malaria in 1658 was a result of his refusal to take "Jesuit's bark" because of Protestant suspicion of anything associated with Roman Catholics. Similarly today, Democrats may choose to die refusing "the Trump cure" rather than accept the shame of admitting even the possibility that HCQ/CQ might actually work against Covid-19.

14 points by drocer88 7y ago

Interesting, I'm bullish on Hydroxychloroquine (not because of any political reasons) but everything I've seen on it working has to do with using it as early as possible (so as close as the onset of symptoms). This study appears to have only administered it to critically ill patients which I would expect to have less of an effect. That said I'm not going to be mad that it appears to have worked for the critically ill (something I have not seen anywhere else really). However, this NOT a randomized-double blind, they say at the end they still need to do one of those to be sure but a fatality rate of 18.8% (with HCQ) vs 45.8& (without) and a p<0.001 is very good news if proven true. Remember this is a pre-print, NOT peer reviewed. It's interesting that we aren't seeing very many studies done with early HCQ dosing. Antivirals like Tamiflu (for the flu) only really help if administer very close to the start of symptoms showing up. We have seen a few Remdesivir that specifically break out when the onset of symptoms was, I wonder why we haven't seen the same for HCQ? Could it be the price difference between HCQ and Remdesivir?

nrr 7y ago
(Disclaimer: I'm not a medical professional, and I don't lay any claim to being authoritative. This is mostly anecdotal.) I suspect the difference in HCQ and remdesivir dosing studies mostly has to do with the classes of drugs those are. One's an antimalarial, and the other's an antiviral. There might be more of a priority to explore what existing antivirals could have an effect. There could also be a sheepishness in wanting to conduct those studies with HCQ given that we still largely don't understand how it works. That said, apropos HCQ being associated with less mortality in advanced cases: As an antimalarial, it has some interesting immunosuppressive properties. Notably, it's used as a treatment for lupus in order to temper or moderate the kind of immune responses seen in those patients. I imagine that there's possibly some sort of (fatal if left untended) immune response that manifests in advanced COVID-19 that HCQ happens to keep down. Writing as an asthmatic who's had his fair share of IV antibiotics to deal with some truly gnarly bouts of pneumonia, acute respiratory distress syndrome is no joke. Any little bit to keep folks off ventilators is truly helpful.
- joshstrange 7y ago
  > There could also be a sheepishness in wanting to conduct those studies with HCQ given that we still largely don't understand how it works. How it works in what way? We have been using it since 1955 and people take it regularly. The risks are largely known. Remdesivir, on the other hand, is just over a decade old and is a drug in search of a problem (it was not useful in treating Ebola and I can't find any reference to it being used for other treatments). Maybe I should say it's an R&D budget in search of recouping the cost. Look, I don't hate Gilead, in fact they make drugs to both treat and preventive HIV/AIDS. The latter being something I've taken before. But something about this all stinks.
  - giardini 6y ago
    joshstrange says>"We have been using it since 1955 and people take it regularly. The risks are largely known."< This. Actually "we" (the Western World) have been using it [quinine and variants] since the 17th century! And it is a fascinating story of political and medical intrigue and skill. Without quinine derived from the bark of the Peruvian cinchona tree, the British, Dutch et al could not have built their empires in malaria-infested regions of the world: "The global history of quinine, the world’s first anti-malaria drug": https://medium.com/@tcassauwers/the-global-history-of-the-world-s-first-anti-malaria-drug-d1e11f0ba729 https://medium.com/@tcassauwers/the-global-history-of-the-wo... There's are many books that discuss this history, among them: "The Miraculous Fever-Tree: Malaria, Medicine and the Cure that Changed the World" by Fiammetta Rocco https://www.amazon.com/Miraculous-Fever-Tree-Malaria-Medicine-Changed-ebook/dp/B0084WVECE https://www.amazon.com/Miraculous-Fever-Tree-Malaria-Medicin... "The Fever: How Malaria Has Ruled Humankind for 500,000 Years" by Sonia Shaw https://www.amazon.com/Fever-Malaria-Ruled-Humankind-Years-ebook/dp/B003R0LBT4 https://www.amazon.com/Fever-Malaria-Ruled-Humankind-Years-e... There was apparently as much anguish between rival groups (Roman Catholics vs. reformists) about cinchona bark (from which quinine was first extracted) in days gone by as there is today between Democrats and Republicans on the use of quinine's descendents, the sythetic drugs known as (hydroxy)chloroquines. It has been said that Oliver Cromwell's death of malaria in 1658 was a result of his refusal to take "Jesuit's bark" because of Protestant suspicion of anything associated with Roman Catholics. Similarly today, Democrats may choose to die refusing "the Trump cure" rather than accept the shame of admitting even the possibility that HCQ/CQ might actually work against Covid-19.