5 ms·

Wasnt Zinc supposed to be part of the equation along with Hydroxychloroquine? Most anecdotal evidence from practitioners includes Zinc along with Hydroxychloroq

by maaand 6y ago

Wasnt Zinc supposed to be part of the equation along with Hydroxychloroquine? Most anecdotal evidence from practitioners includes Zinc along with Hydroxychloroquine.

matthewtoast 6y ago
Yes, and the practitioners boosting the drug combo have also said that in order to be effective, it should be administered early, similar to Tamiflu.
- michaelmrose 6y ago
  So if we kill another thousand people administering it differently how likely are we to discover it now works instead of substantially increasing mortality?
  - matthewtoast 6y ago
    I don't know. We should follow whatever procedures we follow when testing any potential new treatment.
- dmix 6y ago
  I'm curious why there hasn't been a proper prophylactic study of HCQ. Every test I see are hospitalized and late stage. The vast majority of people are told to quarantine at home after testing positive. I'm sure a test group could be made among them to test for severity of symptoms + testing to see the number who are later hospitalized.
  - rsynnott 6y ago
    Giving a dangerous drug to healthy people (presumably thousands of them, to be statistically useful), on no real evidence of efficacy, would be ethically dubious, to say the least.
    - marvin 6y ago
      GP wasn’t suggesting prophylactic use on healthy people. The suggestion was to do this on diagnosed patients, maybe in risk groups, that haven’t progressed to a serious condition yet. But would be at great risk (>10%) to do so soon.
      - deleted 6y ago
        [deleted]
      - meheleventyone 6y ago
        But this study is on outcomes where the treatment was administered within 48 hours of diagnosis.
        giardini 6y ago
        48 hours after _diagnosis_ is pretty damned late. To rephrase that, it's "Two days after diagnosis"! I'd expect the lungs to be fully invaded and serious damage done by the virus by that time. This is not an early, or even seriously prompt, treatment. Certainly if the patients were in a hospital setting this would be unacceptably slow treatment. This appears to be yet another of several "studies" where HCQ was given late to patients that were already near death. Of course it had little effect. The recommendation was always HCQ + AZITHROMYCIN + ZINC SULFATE given EARLY. Few, if any, studies have followed that recommendation.
        marvin 6y ago
        This debate would be EASILY settled by doing real science like you suggest. Instead, we get these proud Trump debunkings that don’t answer the important question. Ok, HCQ doesn’t help critical patients. But we’ve already suspected that for two months. I don’t get it. Just do a simple, proper frickin’ study where the cocktail you mention is used immediately after diagnosis, and compare outcomes with different treatments. This seems so obvious that I wish someone could point out to me what obvious detail I’m not understanding. It’s as if proving Trump wrong is more important than answering the real and important yes/no question.
- marvin 6y ago
  Was this done in the study linked? All doctors I’ve seen promote hydroxychloroquine have been adamant that it must be administered early in the disease’s progression in order to have any effect. But most of the studies being performed that I’ve heard of, have explicitly been on late-stage patients. This includes the central EU study. It would be tragic if the drug works when administered early, but all the studies have happened at a late stage, incorrectly disqualifying a treatment that can save many lives.
  - rsynnott 6y ago
    As mentioned in the paper they only include people where the drug was given within 48 hours after diagnosis.
    - Khelavaster 6y ago
      So, the time between when symptoms first started and up to 48 hours after patients' test results came back positive.
    - giardini 6y ago
      48 hours is two days! "48 hours after diagnosis" is NOT early treatment. See my earlier post!
- DanBC 6y ago
  > Tamiflu. Another drug that doesn't work nearly as well as some people think. https://www.bmj.com/tamiflu https://www.bmj.com/tamiflu > The reviewers concluded that there was no convincing trial evidence that Tamiflu affected influenza complications (in treatment) or influenza infections (in prophylaxis), and raised new questions about the drug’s harms profile.
  - Khelavaster 6y ago
    > Hayashi pointed out that the key piece of evidence underpinning the previous Cochrane review’s conclusion--that Tamiflu reduced the risk of secondary complications such as pneumonia--was based on a manufacturer-authored, pooled analysis of 10 manufacturer-funded trials Everything needed for FDA approval. > no convincing trial evidence It just sounds like Tamiflu efficacy studies to date haven't been thorough enough to be convincing.
michaelmrose 6y ago
Do we have some evidence to back that up?
- maaand 6y ago
  I could find one study: https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1 https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v... Conclusion: This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19. This one is underway: https://clinicaltrials.gov/ct2/show/record/NCT04377646 https://clinicaltrials.gov/ct2/show/record/NCT04377646
  - michaelmrose 6y ago
    Do I read that they just found that zinc + hydroxychloroquine was better than just hydroxychloroquine? That's great but that doesn't exactly tell us that hydroxychloroquine + zinc is better than other therapies or even better than nothing. The clinical trial is regarding the efficacy as a prophylaxis for a small portion of the population that is most directly exposed. It would be great if it works but it will likely not be as useful as a treatment as we can't necessarily give our whole population a years worth without seeing other health consequences.
    - Khelavaster 6y ago
      "They've" observed all sorts of beneficial effects of zinc against viral lung infections fora while, though. "They've" observed hydroxychloroquine molecularly interacts with zinc for at least half a decade.
- Khelavaster 6y ago
  "Chloroquine is a Zinc Ionophore" (2014): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182877/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182877/
phkahler 6y ago
The most impressive one I saw included zinc, but I thought that was unusual. Most do not AFAICT. In fact, zinc may be the beneficial part of that treatment. Any studies on zinc?
- brutt 6y ago
  Hydroxychloroquine is just ionophore for zinc. It just increases concentration of zinc in cell. Zinc inhibits replication of RNA viruses. https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001176 https://journals.plos.org/plospathogens/article?id=10.1371/j...
macinjosh 6y ago
Yes, zinc is a key part of the proposed prophylactic regimen. Anyone who thought HCQ by itself would be helpful as a ‘cure’ for those who already are suffering an infection misunderstood the original proposal and care more about politics than accuracy. (i.e. Mr. Trump)
Natsu 6y ago
This also mixes HCQ with CQ, which seems odd. CQ has a worse safety record and HCQ is normally preferred.
- rsynnott 6y ago
  This provides data for both.
  - Natsu 6y ago
    You're right, I was just confused until I saw the figures where they separated them.
jeremyw 6y ago
Zinc is the purported mechanism of action, but cells can't pick up enough on their own, so an ionophore like hydroxychloroquine might help get more into the cell. One might ask pointed questions why the original formulation (zinc + ionophore) is so consistently absent from these studies. I don't care one way or the other about the drug, but why are studies widely promoted that are irrelevant to the question?

by maaand 6y ago

Wasnt Zinc supposed to be part of the equation along with Hydroxychloroquine? Most anecdotal evidence from practitioners includes Zinc along with Hydroxychloroquine.

matthewtoast 6y ago

Yes, and the practitioners boosting the drug combo have also said that in order to be effective, it should be administered early, similar to Tamiflu.

michaelmrose 6y ago
So if we kill another thousand people administering it differently how likely are we to discover it now works instead of substantially increasing mortality?
- matthewtoast 6y ago
  I don't know. We should follow whatever procedures we follow when testing any potential new treatment.
dmix 6y ago
I'm curious why there hasn't been a proper prophylactic study of HCQ. Every test I see are hospitalized and late stage. The vast majority of people are told to quarantine at home after testing positive. I'm sure a test group could be made among them to test for severity of symptoms + testing to see the number who are later hospitalized.
- rsynnott 6y ago
  Giving a dangerous drug to healthy people (presumably thousands of them, to be statistically useful), on no real evidence of efficacy, would be ethically dubious, to say the least.
  - marvin 6y ago
    GP wasn’t suggesting prophylactic use on healthy people. The suggestion was to do this on diagnosed patients, maybe in risk groups, that haven’t progressed to a serious condition yet. But would be at great risk (>10%) to do so soon.
    - deleted 6y ago
      [deleted]
    - meheleventyone 6y ago
      But this study is on outcomes where the treatment was administered within 48 hours of diagnosis.
      - giardini 6y ago
        48 hours after _diagnosis_ is pretty damned late. To rephrase that, it's "Two days after diagnosis"! I'd expect the lungs to be fully invaded and serious damage done by the virus by that time. This is not an early, or even seriously prompt, treatment. Certainly if the patients were in a hospital setting this would be unacceptably slow treatment. This appears to be yet another of several "studies" where HCQ was given late to patients that were already near death. Of course it had little effect. The recommendation was always HCQ + AZITHROMYCIN + ZINC SULFATE given EARLY. Few, if any, studies have followed that recommendation.
        marvin 6y ago
        This debate would be EASILY settled by doing real science like you suggest. Instead, we get these proud Trump debunkings that don’t answer the important question. Ok, HCQ doesn’t help critical patients. But we’ve already suspected that for two months. I don’t get it. Just do a simple, proper frickin’ study where the cocktail you mention is used immediately after diagnosis, and compare outcomes with different treatments. This seems so obvious that I wish someone could point out to me what obvious detail I’m not understanding. It’s as if proving Trump wrong is more important than answering the real and important yes/no question.
marvin 6y ago
Was this done in the study linked? All doctors I’ve seen promote hydroxychloroquine have been adamant that it must be administered early in the disease’s progression in order to have any effect. But most of the studies being performed that I’ve heard of, have explicitly been on late-stage patients. This includes the central EU study. It would be tragic if the drug works when administered early, but all the studies have happened at a late stage, incorrectly disqualifying a treatment that can save many lives.
- rsynnott 6y ago
  As mentioned in the paper they only include people where the drug was given within 48 hours after diagnosis.
  - Khelavaster 6y ago
    So, the time between when symptoms first started and up to 48 hours after patients' test results came back positive.
  - giardini 6y ago
    48 hours is two days! "48 hours after diagnosis" is NOT early treatment. See my earlier post!
DanBC 6y ago
> Tamiflu. Another drug that doesn't work nearly as well as some people think. https://www.bmj.com/tamiflu https://www.bmj.com/tamiflu > The reviewers concluded that there was no convincing trial evidence that Tamiflu affected influenza complications (in treatment) or influenza infections (in prophylaxis), and raised new questions about the drug’s harms profile.
- Khelavaster 6y ago
  > Hayashi pointed out that the key piece of evidence underpinning the previous Cochrane review’s conclusion--that Tamiflu reduced the risk of secondary complications such as pneumonia--was based on a manufacturer-authored, pooled analysis of 10 manufacturer-funded trials Everything needed for FDA approval. > no convincing trial evidence It just sounds like Tamiflu efficacy studies to date haven't been thorough enough to be convincing.

michaelmrose 6y ago

Do we have some evidence to back that up?

maaand 6y ago
I could find one study: https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v1 https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v... Conclusion: This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19. This one is underway: https://clinicaltrials.gov/ct2/show/record/NCT04377646 https://clinicaltrials.gov/ct2/show/record/NCT04377646
- michaelmrose 6y ago
  Do I read that they just found that zinc + hydroxychloroquine was better than just hydroxychloroquine? That's great but that doesn't exactly tell us that hydroxychloroquine + zinc is better than other therapies or even better than nothing. The clinical trial is regarding the efficacy as a prophylaxis for a small portion of the population that is most directly exposed. It would be great if it works but it will likely not be as useful as a treatment as we can't necessarily give our whole population a years worth without seeing other health consequences.
  - Khelavaster 6y ago
    "They've" observed all sorts of beneficial effects of zinc against viral lung infections fora while, though. "They've" observed hydroxychloroquine molecularly interacts with zinc for at least half a decade.
Khelavaster 6y ago
"Chloroquine is a Zinc Ionophore" (2014): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182877/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182877/

phkahler 6y ago

The most impressive one I saw included zinc, but I thought that was unusual. Most do not AFAICT. In fact, zinc may be the beneficial part of that treatment. Any studies on zinc?

brutt 6y ago
Hydroxychloroquine is just ionophore for zinc. It just increases concentration of zinc in cell. Zinc inhibits replication of RNA viruses. https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001176 https://journals.plos.org/plospathogens/article?id=10.1371/j...

macinjosh 6y ago

Yes, zinc is a key part of the proposed prophylactic regimen. Anyone who thought HCQ by itself would be helpful as a ‘cure’ for those who already are suffering an infection misunderstood the original proposal and care more about politics than accuracy. (i.e. Mr. Trump)

Natsu 6y ago

This also mixes HCQ with CQ, which seems odd. CQ has a worse safety record and HCQ is normally preferred.

rsynnott 6y ago
This provides data for both.
- Natsu 6y ago
  You're right, I was just confused until I saw the figures where they separated them.

jeremyw 6y ago

Zinc is the purported mechanism of action, but cells can't pick up enough on their own, so an ionophore like hydroxychloroquine might help get more into the cell. One might ask pointed questions why the original formulation (zinc + ionophore) is so consistently absent from these studies. I don't care one way or the other about the drug, but why are studies widely promoted that are irrelevant to the question?