8 ms·

Chronic treatment with hydroxychloroquine and SARS-CoV-2 infection

38 points by drocer88 6y ago

blakesterz 6y ago
"After adjustment for age, sex, and chronic treatment with corticosteroids and/or immunosuppressants, the odds ratio of SARS-CoV-2 infection for chronic treatment with HCQ has been 0.51 (0.37-0.70). Conclusions: Our data suggest that chronic treatment with HCQ confer protection against SARS-CoV-2 infection." Assuming this really does help protect against one virus, I wondered does that mean it would help protect against ALL or ANY other virus as well? There's no small number of people that have been taking this for a long time already, do they tend to catch colds or the flu or other virus caused illness less than other folks?
- stevespang 6y ago
  Indeed . ..
- LyndsySimon 6y ago
  > After adjustment for age, sex, and chronic treatment with corticosteroids and/or immunosuppressants [...] Interestingly, I didn't see from the summary that they were controlling for the conditions for which individuals were being treated with HCQ and the impact they had on their lives. If people with Lupus are treated with HCQ (they are) and people with Lupus are often forced to make behavioral changes like staying indoors and out of the sun and avoiding physically demanding activities - which they are - doesn't it seem reasonable that those lifestyle changes would result in fewer SARS-CoV-2 infections? FWIW, I'm very much open to the idea that HCQ may be a viable treatment for COVID-19. I've not kept up with the clinical results since it became a political issue, but it originally seemed to be a promising avenue of research. Once Trump started talking about it, it became all but impossible to find data about its effectiveness that wasn't obviously politically motivated. This paper doesn't appear to be politically motivated... but it also doesn't appear to provide strong evidence one way or another.
  - pariahHN 6y ago
    I was also wondering about this. No discussion of the likelihood of someone who knows about their condition and is being treated for it being exposed in the first place. If they had a lower likelihood in the first place then it would also look like HCQ had the desired effect. I am interested by a couple of their references, specifically regarding the possibility of HCQ only working as a prophylactic after a sufficiently long period of exposure. That could be a contributor to difficulty in replication.
deleted 6y ago
[deleted]
cliffy 6y ago
This hasn't even been peer reviewed yet. Don't expect that you, the average HN reader, knows better than reviewers with relevant backgrounds.
- lbeltrame 6y ago
  Peer review, while extremely useful in bringing out some, or many warts of a work, is not a substitute for quality control, which depends only on the authors. > Don't expect that you, the average HN reader, knows better than reviewers with relevant backgrounds. After what happened with the Surgisphere paper, where the first problem was the statistics (caught by post-publication comments) and only later there was the problem of fake data, the mere presence of a secret review does not mean the work is up to anything. P.S: yes, I work in the fields of biology and pharmacology and have written and reviewed a number of papers myself.
  - dekhn 6y ago
    I still think it's a fair comment that most Hacker News readers are not the audience for pre-prints. It's simply not possible for people untrained in the art of reading papers in a specific field to make reasoned judgements.
  - deleted 6y ago
    [deleted]
- LyndsySimon 6y ago
  Out of curiosity, do you happen to have handy the proportion of papers submitted for publication that do not pass peer review? I've worked in the scientific publishing field (though, admittedly, as a lay person) and remain generally unimpressed by the process. At best, I tend to see a paper having been accepted for publication as a positive signal - certainly not as a clear indicator.
  - osamagirl69 6y ago
    It depends highly on the journal. In my field (optics) for a 'high impact' journal (which a paper claiming to show a way to curb the covid-19 pandemic would certainly qualify for) the accept rate is about 10% after multiple rounds of review/revision. After your paper gets rejected from a top journal you apply to a mid-tier journal (usually for reasons related to impact, but this is tied to your claims that are not watertight being struck out in the review) which has about a 50% accept rate after you remove the unproven claims. Then when you don't get accepted there you go to a 'just publish my paper' journal, which comes in 2 flavors: The respectable move is to publish in a technical archive (nature scientific reports is a good example of this) where you only have to satisfy that the work is technically sound, so you remove all of the unsubstantiated claims (title goes from 'we cured covid' to 'statistical analysis of covid patients--results inconclusive') and publish your measurements and methods. The less respectable way out is to publish in a journal with a fast-track review process that just accepts anything as long as you pay the fees. Usually people in the field are smart enough to ignore papers in those journals, but bean counters and media aren't.
acqq 6y ago
There must be a prize for this kind of work. "- 360,304 patients with suspected SARS-CoV-2 infection - Of these 360,304 cases, 26,815 were confirmed by a positive PCR test. The rest had negative PCR tests. - In the set of patients with case definition, 1,292 received HCQ (at least 2 grams per month) - The proportion of HCQ chronic treatment was higher in negative patients (0.36% vs. 0.29%, P = 0.04) - We were able to show that patients taking HCQ have had reduced odds of SARS-CoV-2 infection" No joke, that is the basis for their claim. Just like "compared to those that we suspected could have tested positive, it turned out that among those that weren't positive there were more people proportionally receiving HCQ." I don't understand how that can actually prove something. One can surely find a lot of things that are proportionally more present in those tested negative, but without any meaning.
- gridlockd 6y ago
  That's how screening for drug treatments often works. You look for those kinds of correlations. You move on from there. With many drugs, we don't even know how or why they work for certain things, but we prescribe them anyway. There's nothing wrong with the claim, it seems to be factually accurate. The authors are not claiming that HCQ is an effective treatment, they say the data suggests that HCQ is protective.
  - acqq 6y ago
    > they say the data suggests that HCQ is protective. Only, I fail to see that the data does that. And their explicit claim is, which I specifically quoted directly from the paper: "We were able to show that patients taking HCQ have had reduced odds of SARS-CoV-2 infection" It's not different than "there were more people believing in Santa Claus proportionally in those negatively tested, so that means that Santa Claus belief reduced odds of SARS-CoV-2 infection." It just doesn't. Even if A is true, in such a construct B doesn't follow. Like it was already noted, those treated could have been also less willing to do risky things. Or it could have been a mere coincidence, like in the Santa Claus example.
    - gridlockd 6y ago
giardini 6y ago
2005 article (on an in-vitro study) also: "Chloroquine is a potent inhibitor of SARS coronavirus infection and spread" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1232869/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1232869/
drocer88 6y ago
Articles like this don't need the "flagged" treatment. HCQ studies need serious review and discussion. The theory has always been that HCQ increases Zinc in the cell which blocks viral replication ,might have a small effect and might help with early infection. Research like this does not need the heated politics. We need good clinical trials and reproduced studies.
- tumetab1 6y ago
  Agree and what does "flagged" in HN mean? :\ The FAQ and Guidelines doesn't explain it. I was following this post to see if more knowledgable people would comment if this study seems good or not (since I have no idea).
  - gridlockd 6y ago
    It means that enough people flagged it, so it got flagged. The motivation for flagging is probably something along the lines of "this surely will promote poor quality discussion". Less visibility means less discussion.
brodouevencode 6y ago
Consider https://news.ycombinator.com/from?site=medrxiv.org https://news.ycombinator.com/from?site=medrxiv.org Of all the nearly 160 posts from this domain, only three are flagged. Three that have, through various sociological and political reasons, become toxic or divisive to a large degree. The content/conclusion itself shouldn't be political, but that's where we are at.

38 points by drocer88 6y ago

"After adjustment for age, sex, and chronic treatment with corticosteroids and/or immunosuppressants, the odds ratio of SARS-CoV-2 infection for chronic treatment with HCQ has been 0.51 (0.37-0.70). Conclusions: Our data suggest that chronic treatment with HCQ confer protection against SARS-CoV-2 infection." Assuming this really does help protect against one virus, I wondered does that mean it would help protect against ALL or ANY other virus as well? There's no small number of people that have been taking this for a long time already, do they tend to catch colds or the flu or other virus caused illness less than other folks?

stevespang 6y ago
Indeed . ..
LyndsySimon 6y ago
> After adjustment for age, sex, and chronic treatment with corticosteroids and/or immunosuppressants [...] Interestingly, I didn't see from the summary that they were controlling for the conditions for which individuals were being treated with HCQ and the impact they had on their lives. If people with Lupus are treated with HCQ (they are) and people with Lupus are often forced to make behavioral changes like staying indoors and out of the sun and avoiding physically demanding activities - which they are - doesn't it seem reasonable that those lifestyle changes would result in fewer SARS-CoV-2 infections? FWIW, I'm very much open to the idea that HCQ may be a viable treatment for COVID-19. I've not kept up with the clinical results since it became a political issue, but it originally seemed to be a promising avenue of research. Once Trump started talking about it, it became all but impossible to find data about its effectiveness that wasn't obviously politically motivated. This paper doesn't appear to be politically motivated... but it also doesn't appear to provide strong evidence one way or another.
- pariahHN 6y ago
  I was also wondering about this. No discussion of the likelihood of someone who knows about their condition and is being treated for it being exposed in the first place. If they had a lower likelihood in the first place then it would also look like HCQ had the desired effect. I am interested by a couple of their references, specifically regarding the possibility of HCQ only working as a prophylactic after a sufficiently long period of exposure. That could be a contributor to difficulty in replication.

deleted 6y ago

[deleted]

cliffy 6y ago

This hasn't even been peer reviewed yet. Don't expect that you, the average HN reader, knows better than reviewers with relevant backgrounds.

lbeltrame 6y ago
Peer review, while extremely useful in bringing out some, or many warts of a work, is not a substitute for quality control, which depends only on the authors. > Don't expect that you, the average HN reader, knows better than reviewers with relevant backgrounds. After what happened with the Surgisphere paper, where the first problem was the statistics (caught by post-publication comments) and only later there was the problem of fake data, the mere presence of a secret review does not mean the work is up to anything. P.S: yes, I work in the fields of biology and pharmacology and have written and reviewed a number of papers myself.
- dekhn 6y ago
  I still think it's a fair comment that most Hacker News readers are not the audience for pre-prints. It's simply not possible for people untrained in the art of reading papers in a specific field to make reasoned judgements.
- deleted 6y ago
  [deleted]
LyndsySimon 6y ago
Out of curiosity, do you happen to have handy the proportion of papers submitted for publication that do not pass peer review? I've worked in the scientific publishing field (though, admittedly, as a lay person) and remain generally unimpressed by the process. At best, I tend to see a paper having been accepted for publication as a positive signal - certainly not as a clear indicator.
- osamagirl69 6y ago
  It depends highly on the journal. In my field (optics) for a 'high impact' journal (which a paper claiming to show a way to curb the covid-19 pandemic would certainly qualify for) the accept rate is about 10% after multiple rounds of review/revision. After your paper gets rejected from a top journal you apply to a mid-tier journal (usually for reasons related to impact, but this is tied to your claims that are not watertight being struck out in the review) which has about a 50% accept rate after you remove the unproven claims. Then when you don't get accepted there you go to a 'just publish my paper' journal, which comes in 2 flavors: The respectable move is to publish in a technical archive (nature scientific reports is a good example of this) where you only have to satisfy that the work is technically sound, so you remove all of the unsubstantiated claims (title goes from 'we cured covid' to 'statistical analysis of covid patients--results inconclusive') and publish your measurements and methods. The less respectable way out is to publish in a journal with a fast-track review process that just accepts anything as long as you pay the fees. Usually people in the field are smart enough to ignore papers in those journals, but bean counters and media aren't.

acqq 6y ago

There must be a prize for this kind of work. "- 360,304 patients with suspected SARS-CoV-2 infection - Of these 360,304 cases, 26,815 were confirmed by a positive PCR test. The rest had negative PCR tests. - In the set of patients with case definition, 1,292 received HCQ (at least 2 grams per month) - The proportion of HCQ chronic treatment was higher in negative patients (0.36% vs. 0.29%, P = 0.04) - We were able to show that patients taking HCQ have had reduced odds of SARS-CoV-2 infection" No joke, that is the basis for their claim. Just like "compared to those that we suspected could have tested positive, it turned out that among those that weren't positive there were more people proportionally receiving HCQ." I don't understand how that can actually prove something. One can surely find a lot of things that are proportionally more present in those tested negative, but without any meaning.

gridlockd 6y ago
That's how screening for drug treatments often works. You look for those kinds of correlations. You move on from there. With many drugs, we don't even know how or why they work for certain things, but we prescribe them anyway. There's nothing wrong with the claim, it seems to be factually accurate. The authors are not claiming that HCQ is an effective treatment, they say the data suggests that HCQ is protective.
- acqq 6y ago
  > they say the data suggests that HCQ is protective. Only, I fail to see that the data does that. And their explicit claim is, which I specifically quoted directly from the paper: "We were able to show that patients taking HCQ have had reduced odds of SARS-CoV-2 infection" It's not different than "there were more people believing in Santa Claus proportionally in those negatively tested, so that means that Santa Claus belief reduced odds of SARS-CoV-2 infection." It just doesn't. Even if A is true, in such a construct B doesn't follow. Like it was already noted, those treated could have been also less willing to do risky things. Or it could have been a mere coincidence, like in the Santa Claus example.
  - gridlockd 6y ago

giardini 6y ago

2005 article (on an in-vitro study) also: "Chloroquine is a potent inhibitor of SARS coronavirus infection and spread" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1232869/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1232869/

drocer88 6y ago

Articles like this don't need the "flagged" treatment. HCQ studies need serious review and discussion. The theory has always been that HCQ increases Zinc in the cell which blocks viral replication ,might have a small effect and might help with early infection. Research like this does not need the heated politics. We need good clinical trials and reproduced studies.

tumetab1 6y ago
Agree and what does "flagged" in HN mean? :\ The FAQ and Guidelines doesn't explain it. I was following this post to see if more knowledgable people would comment if this study seems good or not (since I have no idea).
- gridlockd 6y ago
  It means that enough people flagged it, so it got flagged. The motivation for flagging is probably something along the lines of "this surely will promote poor quality discussion". Less visibility means less discussion.

brodouevencode 6y ago

Consider https://news.ycombinator.com/from?site=medrxiv.org https://news.ycombinator.com/from?site=medrxiv.org Of all the nearly 160 posts from this domain, only three are flagged. Three that have, through various sociological and political reasons, become toxic or divisive to a large degree. The content/conclusion itself shouldn't be political, but that's where we are at.