6 ms·

Early treatment of Covid-19 with HCQ and AZ:retrospective analysis of 1061 cases

53 points by sandGorgon 6y ago

lbeltrame 6y ago
Note: this is from Didier Raoult's group, the one who published a rather controversial study on a very limited number of patients last month. I just skimmed through the paper, but what attracted my eye is the mention of severity at admission being a risk factor (but the confidence intervals are huge so I don't know what to make of it).
- prox 6y ago
  I believe a european study is on-going if I recall. Another issue is the discovery of micro thrombi in severe patients.
- godelzilla 6y ago
  The dishonesty of this group is manifest in the quote: "Finally, a retrospective analysis of data from patients hospitalized with confirmed SARS-CoV-2 infection in all United States Veterans Health Administration medical centers found no evidence that, before ventilation, the use of HCQ either with or without AZ, reduced the need for subsequent mechanical ventilation" Compared with what the paper actually says: "In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone." https://www.medrxiv.org/content/medrxiv/early/2020/04/23/2020.04.16.20065920.full.pdf https://www.medrxiv.org/content/medrxiv/early/2020/04/23/202...
klmadfejno 6y ago
As far as I can tell, this is not a controlled study, but just an analysis of a bunch of people who took the drugs at a pretty low dosage. The analysis doesn't (and couldn't) make any conclusions about HCQ improving patient outcomes vs. not using HCQ; but rather just tries to assert that it didn't make things worse and we should therefore do it because China says it's a good idea. Without any baseline it's not clear to me how one could evaluate these claims. Sounds just about as useful as the previous paper. As an aside, I do feel like the mean age of poor clinical outcomes, 69, feels a bit low relative to my expectations.
- forgot_user1234 6y ago
  > any conclusions about HCQ did you read this "A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years – range 14–95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). " > l, this is not a controlled study, You can retrospectively get the control data for same time frame. This won't br same as placebo but still good. AND, death rate in france for closed cases is around - 15-25% . Death rate with HCQ+AZ is 0.75% If I got crona. I will take the HCQ+AZ
  - klmadfejno 6y ago
    91.7% for a sample of 1,061 people with a non trivial subset removed because of pre-existing health issues isn't that noteworthy. Given only the mean age, it's very difficult to know what the baseline levels should be. Averages are not realistic. They depend on the age and health of individuals. The concern about placebos is a thing, yes, but the real problem is that the rates of poor clinical outcomes are not standard. You could get a decent estimate by looking at other results coming out of this hospital from a similar age and health cohort, but that's not here in this paper. The baseline mortality rate for an average individual below age 60 is nowhere close to 15%, but of course, it all depends. It's probably fine if you want to take the drug, but accurate statistical reasoning is not the driver of that decision.
  - arcticbull 6y ago
    > Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). I think that's pretty typical in untreated patients. Average recovery period is about two weeks. [1] > Death rate with HCQ+AZ is 0.75% The death rate of COVID-19 in the general population is less than 1% (0.25%-1% depending on the study). Even New York, the worst city (by case count, and fatalities) in the worst country in the world is ~0.7%. All this study shows is that HCQ+AZ doesn't kill people faster than not taking HCQ+AZ. > AND, death rate in france for closed cases is around - 15-25%. Not worth re-hashing CFR vs. IFR (and the associated adverse selection risk) but you won't get anything approximating your risk without referencing serological studies. I can't stress how this number is not representative, and treating with HCQ+AZ does not by any means get the number from 15-25% down to 0.7% [1] https://www.bbc.com/news/health-52301633 https://www.bbc.com/news/health-52301633
newacct583 6y ago
This is so infuriating. This might work. It might not. Data is still (and must be, really) still anecdotal. It will be a year or more before high quality studies are done. Yet we have to argue about the ?!@#!$ thing repeatedly, because public figures (we all know who) decided to push this idea irresponsibly as a miracle cure. So now all the people on one side of the discussion have to crow about every positive result as if it vindicates the original rhetoric. It does not. I mean, this might work a little! It might save some lives at the margin. It's not going to significantly affect the course of the pandemic. It's just not.
- klmadfejno 6y ago
  > It does not. I mean, this might work a little! It might save some lives at the margin. It's not going to significantly affect the course of the pandemic. It's just not. This is a really good take on it for those who aren't into reading scientific papers. It's totally plausible HCQ does help a bit. If true, it changes virtually nothing about our current situation. The decision making is all the same.
  - lbeltrame 6y ago
    > If true, it changes virtually nothing about our current situation. Honest question: why? (Note: my background includes pharmacology, so I am more interested in pharmacological options rather than vaccines)
    - mlyle 6y ago
      If we end up with a treatment that swings infection fatality rate from 0.6% to 0.55% and reduces hospital stay time by 15%-- and HCQ probably does less than this-- the public policy choices we'd want to make are basically identical. Peak hospital load for a wave is lowered by much less than 15%; body count is just about as bad. Yes, everyone who has their life saved by this treatment is happy, and it's worth chasing small improvements on the margin... but... (It's worth noting that the (very) little evidence from controlled trials that we have leans more in the direction of harm than benefit, too. But the same argument holds for e.g. remdesivir where we do have some decent evidence).
narrator 6y ago
HCQ is also used in Costa Rica[1] for every patient and they have a very low death rate[2]. It's interesting that since it's such a cheap widely available drug, and even produced locally in Costa Rica, that developing countries can use it for every case. [1]https://qcostarica.com/hydroxychloroquine-the-drug-costa-rica-uses-successfully-to-fight-covid-19/ https://qcostarica.com/hydroxychloroquine-the-drug-costa-ric... [2] https://www.worldometers.info/coronavirus/country/costa-rica/ https://www.worldometers.info/coronavirus/country/costa-rica...
greatgib 6y ago
Still, no raw/source data provided with the study. Everyone has to wonder why you would publish results without publication of the sources when you want to convince people with an important subject...
steeve 6y ago
I'm glad HN is not jumping on the HCQ bandwagon blindly, and actively reads the studies which, unfortunately for all of us, don't show anything. It is quite disturbing, however, to see on French Twitter, the far right, complotists, nationalists, and even bots push Raoult so hard...
- lbeltrame 6y ago
  Personally I'm not interested much in what Raoult says or not. The fact that he might be shady and eccentric does not make the null hypothesis true (nor the alternative hypothesis, of course). I'm confident that the COVID-19 PEP trial by U of Minnesota will help put an end to this polarized debate on the use of HCQ (which for most part has nothing scientific going on).
  - steeve 6y ago
    That was my point. They are pushing Raoult the persona, and are never talking about the studies.

53 points by sandGorgon 6y ago

Note: this is from Didier Raoult's group, the one who published a rather controversial study on a very limited number of patients last month. I just skimmed through the paper, but what attracted my eye is the mention of severity at admission being a risk factor (but the confidence intervals are huge so I don't know what to make of it).

prox 6y ago
I believe a european study is on-going if I recall. Another issue is the discovery of micro thrombi in severe patients.
godelzilla 6y ago
The dishonesty of this group is manifest in the quote: "Finally, a retrospective analysis of data from patients hospitalized with confirmed SARS-CoV-2 infection in all United States Veterans Health Administration medical centers found no evidence that, before ventilation, the use of HCQ either with or without AZ, reduced the need for subsequent mechanical ventilation" Compared with what the paper actually says: "In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone." https://www.medrxiv.org/content/medrxiv/early/2020/04/23/2020.04.16.20065920.full.pdf https://www.medrxiv.org/content/medrxiv/early/2020/04/23/202...

klmadfejno 6y ago

As far as I can tell, this is not a controlled study, but just an analysis of a bunch of people who took the drugs at a pretty low dosage. The analysis doesn't (and couldn't) make any conclusions about HCQ improving patient outcomes vs. not using HCQ; but rather just tries to assert that it didn't make things worse and we should therefore do it because China says it's a good idea. Without any baseline it's not clear to me how one could evaluate these claims. Sounds just about as useful as the previous paper. As an aside, I do feel like the mean age of poor clinical outcomes, 69, feels a bit low relative to my expectations.

forgot_user1234 6y ago
> any conclusions about HCQ did you read this "A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years – range 14–95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). " > l, this is not a controlled study, You can retrospectively get the control data for same time frame. This won't br same as placebo but still good. AND, death rate in france for closed cases is around - 15-25% . Death rate with HCQ+AZ is 0.75% If I got crona. I will take the HCQ+AZ
- klmadfejno 6y ago
  91.7% for a sample of 1,061 people with a non trivial subset removed because of pre-existing health issues isn't that noteworthy. Given only the mean age, it's very difficult to know what the baseline levels should be. Averages are not realistic. They depend on the age and health of individuals. The concern about placebos is a thing, yes, but the real problem is that the rates of poor clinical outcomes are not standard. You could get a decent estimate by looking at other results coming out of this hospital from a similar age and health cohort, but that's not here in this paper. The baseline mortality rate for an average individual below age 60 is nowhere close to 15%, but of course, it all depends. It's probably fine if you want to take the drug, but accurate statistical reasoning is not the driver of that decision.
- arcticbull 6y ago
  > Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). I think that's pretty typical in untreated patients. Average recovery period is about two weeks. [1] > Death rate with HCQ+AZ is 0.75% The death rate of COVID-19 in the general population is less than 1% (0.25%-1% depending on the study). Even New York, the worst city (by case count, and fatalities) in the worst country in the world is ~0.7%. All this study shows is that HCQ+AZ doesn't kill people faster than not taking HCQ+AZ. > AND, death rate in france for closed cases is around - 15-25%. Not worth re-hashing CFR vs. IFR (and the associated adverse selection risk) but you won't get anything approximating your risk without referencing serological studies. I can't stress how this number is not representative, and treating with HCQ+AZ does not by any means get the number from 15-25% down to 0.7% [1] https://www.bbc.com/news/health-52301633 https://www.bbc.com/news/health-52301633

newacct583 6y ago

This is so infuriating. This might work. It might not. Data is still (and must be, really) still anecdotal. It will be a year or more before high quality studies are done. Yet we have to argue about the ?!@#!$ thing repeatedly, because public figures (we all know who) decided to push this idea irresponsibly as a miracle cure. So now all the people on one side of the discussion have to crow about every positive result as if it vindicates the original rhetoric. It does not. I mean, this might work a little! It might save some lives at the margin. It's not going to significantly affect the course of the pandemic. It's just not.

klmadfejno 6y ago
> It does not. I mean, this might work a little! It might save some lives at the margin. It's not going to significantly affect the course of the pandemic. It's just not. This is a really good take on it for those who aren't into reading scientific papers. It's totally plausible HCQ does help a bit. If true, it changes virtually nothing about our current situation. The decision making is all the same.
- lbeltrame 6y ago
  > If true, it changes virtually nothing about our current situation. Honest question: why? (Note: my background includes pharmacology, so I am more interested in pharmacological options rather than vaccines)
  - mlyle 6y ago
    If we end up with a treatment that swings infection fatality rate from 0.6% to 0.55% and reduces hospital stay time by 15%-- and HCQ probably does less than this-- the public policy choices we'd want to make are basically identical. Peak hospital load for a wave is lowered by much less than 15%; body count is just about as bad. Yes, everyone who has their life saved by this treatment is happy, and it's worth chasing small improvements on the margin... but... (It's worth noting that the (very) little evidence from controlled trials that we have leans more in the direction of harm than benefit, too. But the same argument holds for e.g. remdesivir where we do have some decent evidence).

narrator 6y ago

HCQ is also used in Costa Rica[1] for every patient and they have a very low death rate[2]. It's interesting that since it's such a cheap widely available drug, and even produced locally in Costa Rica, that developing countries can use it for every case. [1]https://qcostarica.com/hydroxychloroquine-the-drug-costa-rica-uses-successfully-to-fight-covid-19/ https://qcostarica.com/hydroxychloroquine-the-drug-costa-ric... [2] https://www.worldometers.info/coronavirus/country/costa-rica/ https://www.worldometers.info/coronavirus/country/costa-rica...

greatgib 6y ago

Still, no raw/source data provided with the study. Everyone has to wonder why you would publish results without publication of the sources when you want to convince people with an important subject...

steeve 6y ago

I'm glad HN is not jumping on the HCQ bandwagon blindly, and actively reads the studies which, unfortunately for all of us, don't show anything. It is quite disturbing, however, to see on French Twitter, the far right, complotists, nationalists, and even bots push Raoult so hard...

lbeltrame 6y ago
Personally I'm not interested much in what Raoult says or not. The fact that he might be shady and eccentric does not make the null hypothesis true (nor the alternative hypothesis, of course). I'm confident that the COVID-19 PEP trial by U of Minnesota will help put an end to this polarized debate on the use of HCQ (which for most part has nothing scientific going on).
- steeve 6y ago
  That was my point. They are pushing Raoult the persona, and are never talking about the studies.