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Low-dose Hydroxychloroquine Therapy and Mortality in Hospitalized Patients
- cdiamand 6y agoThis seems like good news. Is hydroxychloroquine currently being prescribed widely?
- rs999gti 6y ago> This seems like good news. Is hydroxychloroquine currently being prescribed widely? Sort of. Since Trump tweeted and mentioned the drug, hydroxychloroquine has become politicized. Some scientists and doctors say it might have some use. But the media is critical of it because Trump mentioned it.
- firmnoodle 6y agoDown voted for stating facts...
- bradford 6y ago> But the media is critical of it because Trump mentioned it. What an odd conclusion to draw. I think it would be more accurate to say: Trump is being criticized for hyping a medication that has not yet undergone medical trials. There's an established method for bringing medication to market. Trump is ignorant of that method. That's why he's being criticized.
- gizmo 6y agoHCQ is not a new drug. It's widely available globally. It has been used as an antiviral therapeutic and to prevent malaria since the 50s or so.
- lucd 6y agoMedical misinformation : Malaria is caused by a parasite, not a virus. For Lupus or RA hydroxychloroquine helps through its anti-inflammatory and immunosuppressive properties.
- deleted 6y ago[deleted]
- Khelavaster 6y agoHydroxychloroquine also directly inhibits heme breakdown, a weak point in malaria parasites' blood digestion. Beyond its standard antiviral and immunomodulatory activity, it's thought that hydroxychloroquine protects red blood cells' heme molecules from having their iron ripped out by Covid.
- bradford 6y agoRight, It's not a new drug, but its efficacy for treating COVID-19 has not been established. Using it to treat COVID-19 prior to completion of medical trials is premature and has the potential to cause more harm than good. "widely available globally" and "has been used as an antiviral therapeutic" is not the correct criteria to use here.
- ikerdanzel 6y agoI suggest you try to get in touch with those people working in Asian sides using it as treatment. Most don't publish their results there but do use it. And you can see a significant low mortality compare to western countries that largely choose not to use it. South and Eastern Asian side has very high infection rates way more than western counterpart and yet mortality is significantly lower both in terms of absolute value or by percentage.
- ryathal 6y agoOff label uses of drugs has been common for decades. Trials aren't just spun up without some evidence of anecdotes to support them being worth the effort. If anything a drug with well understood side effects and a plausible method of actually being helpful is probably worth trying while formal trials can be conducted.
- gizmo 6y agoWhen you're dealing with a new disease there are no best practices for treatment. This is tautologically true. That's why doctors have to use their best judgement and try different things and write down what seems to work and what doesn't. Often they get it wrong, with very bad consequences. For instance putting covid patients prematurely on mechanical ventilators had catastrophic health implications. When this became apparent ventilator policy changed. People died and now we know better. It's ugly, but that's how you learn about treating a new(ish) disease. Waiting for the results of multiple randomized controlled trials is, frankly, fantasy. Covid has almost entirely ran its course and we aren't close to having solid treatment results from randomized controlled trials. Premature and ad-hoc treatment is how we've muddled through the pandemic, and it's how we'll muddle through the next pandemic, too.
- pelasaco 6y agoit is unfortunately like that. Not just in US but in Brazil too. I don't know if it works. I don't like any politician. But it's true that both sides (left and right) are politicizing the drug.
- DFHippie 6y agoA tableau: Politician A does something outrageous for political gain. A's opponents in party B decry this outrageous action as being outrageous and done for political gain. Decrying things A does is to B's political advantage! Conclusions: everyone is politicizing this issue. Maybe we need a better metric for evaluating political action than whether the actors see some political benefit.
- nl 6y agoIt's such a pity how politicised hydroxychloroquine has become. It's stupid to believe in miracle cures. But it's also stupid to discard out of hand things for which evidence is unclear just because your opponent is irrationally keen on it.
- chromedev 6y agoWhat makes you think that is the case? You're politicizing it right now.
- dx87 6y agoI was watching the Joe Rogan podcast, and one of his friends who had covid was asked by the doctor what his political leanings are, because some patients refuse to take HCQ because Trump said it was helpful.
- chromedev 6y agoJoe Rogan isn't the best example to base your political opinions. There are also serious safety issues: https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or https://www.fda.gov/drugs/drug-safety-and-availability/fda-c...
- giardini 6y agoFewer votes against Trump unless, like good Democrats, they mail in all their ballots before they die!8-))
- deleted 6y ago[deleted]
- bena 6y agoYes, it would be stupid. But is that what's happening here? You have a ton of studies that says "no" and a few that say "maybe". But you want us to what? Keep studying until it finally says "yes"? "Check this out, it shows promise" "Ok." "Oh, it's not as effective as initially thought" "Ok, but this study says it might be" "Ok, but we just did a full study that says it's not" "Ok, but this study" And on and on. At what point do you say, "Ok, I guess we should move on". It was never discarded out of hand.
- f154hfds 6y agoThis fascinating article was posted on HN a few days ago: https://news.ycombinator.com/item?id=24251718 https://news.ycombinator.com/item?id=24251718 It talks about the history of the HCQ debacle and in the process taught me quite a lot about medical study methodology/epistemology.
- jimhefferon 6y agoIt appears to, at one point, just as a sideline, sneer at those who assert that homeopathy is quackery. To at least my layman's mind, that considerably drops the credibility of anything else it says.
- deleted 6y ago[deleted]
- f154hfds 6y agoI looked for homeopathy in the article to understand what you were getting at. To disregard a long article such as this on one sentence doesn't seem fair. The article if anything is about epistemology - so the sneer is in reference to doctors assuming they 'know' the only correct ways to draw conclusions (and the article did take a dark twist indeed referencing the opioid epidemic). As a layman though, I don't know what it is referring to about Europe's relationship to homeopathy. I would be curious for a more knowledgeable person to weigh in on that.
- jimhefferon 6y agoWell, as I say, I am a layman. To a person like me, trying to judge from what I do know, that was a show-stopper.
- validuser 6y ago1. Not a low dose (400mg/week should be enough from what I've read) 2. No mention of zinc supplements, which seems to be the key to make the Hydroxychloroquine effective
- JumpCrisscross 6y ago> No mention of zinc supplements, which seems to be the key to make the Hydroxychloroquine effective Clearly not.
- jbritton 6y agoTo my knowledge there has not yet been a trial completed with HCQ+Zinc. There are several doctors stating positive observational results with HCQ+Zinc. I’m waiting for this study to complete: https://clinicaltrials.gov/ct2/show/NCT04370782 https://clinicaltrials.gov/ct2/show/NCT04370782 Zinc has antiviral properties. It has been shown to stop Sars Cov2 replication in-vitro. Cells limit their Zinc intake. HCQ facilitates Zinc getting into cells.
- gojomo 6y agoYes, it's been amazing to me how nearly everyone with continuing interest in HCQ has emphasized Zinc as an important factor, while so many studies have ignored it: neither supplementing it nor even checking enrolled patients for zinc deficiencies (which may be especially prevalent in the aged or those with known Covid comorbidities). So I'll see, for example, some otherwise-highly-credible UCSF researchers mention a bunch of evidence they think puts the potential of HCQ to help to rest, without any mention of Zinc considerations (even in passing, or to ridicule, or to share why they don't think the link credible). But even coincident upon the very 1st discussions of HCQ as having potential, Derek Lowe shared an anecdote about how carrying-Zinc seemed essential to Chloroquine-related-compoounds' bioactivity (https://blogs.sciencemag.org/pipeline/archives/2020/03/20/chloroquine-past-and-present https://blogs.sciencemag.org/pipeline/archives/2020/03/20/ch...). And, in many parts of the world, HCQ – as a cheap drug that, in moderate doses with proper monitoring, is very low-risk – is already considered part of the Covid-19 "standard-of-care". So, it's given even to the 'control' arms of trials for other compounds – making both its effects, and those other compounds' effects, harder to disentangle. All I want now is true randomized trials - and can't at least one of those monitor, or vary the supplementation of, Zinc as well?
- AaronFriel 6y agoI'm unfortunately completely unprepared to read a study like this and criticize it, but I do think that there's reason to believe the effect is close to zero. Why? Because more than one randomized controlled trial have produced zero effects compared to placebo. https://www.washingtonpost.com/health/2020/07/16/hydroxychloroquine-studies-show-drug-is-not-effective-early-treatment-mild-covid-19/ https://www.washingtonpost.com/health/2020/07/16/hydroxychlo...
- underdown 6y agoI have no idea if hcq is effective, but I'm not sure that study you linked was meaningful. FTA "The first randomized clinical trial testing hydroxychloroquine as an early treatment for mild covid-19 found the drug was no better than a placebo in patients who were not hospitalized." So, maybe hcq has no effect on outcomes on mild cases. This does not mean it couldn't have an effect on severe/hospitalized patients.
- AaronFriel 6y agoIt might be telling that the article linked to two separate studies? I'm not sure if you read the whole article.
- underdown 6y agoI did. The other study is similar in design. FTA "The new study was a companion to a randomized trial by the same researchers published last month. Those results showed the drug is not effective in preventing covid-19 in healthy people exposed to the coronavirus."
- labcomputer 6y ago> So, maybe hcq has no effect on outcomes on mild cases. This does not mean it couldn't have an effect on severe/hospitalized patients. Sure, but that's the exact opposite of the earlier narrative when the trials in Brazil were called off. (paraphrasing) "Sure, it doesn't help people who are critically ill, but you should use it as a prophylactic to prevent milder cases from becoming more severe". So... it doesn't work in patients with a mild, moderate or severe case; (per the earlier advice) it must be prescribed after infection but before symptoms develop; and it must be prescribed in doses that are known to cause heart problems in a significant portion of the population (so significant, in fact, that patients prescribed much lower doses of HCQ are normally required to be regularly monitored for the onset of said problems). At what point do you admit that any positive effect of HCQ is just cherry-picking/p-value-hacking?
- srmatto 6y agoMy experience with becoming infected with covid-19 and taking Hydroxychloroquine, azithromycin, and Zinc sulphate for five days was positive. My total time to recover from first sign of symptoms to becoming healthy again was about 11 days. I obviously can't and therefore won't make any claims that my experience is the direct result of taking those medications. Here's a tracker that lists studies: https://c19study.com/ https://c19study.com/
- polote 6y agoWell, your single personal experience can't be a proof of what treatment is working. Even more when we know that you had a 99% chance of recovering
- epmaybe 6y agoSeems like your symptom resolution was about the median for most patients infected with covid. http://cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm http://cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm
- vernie 6y agoHow did it compare to the other time you got COVID-19 and didn't take HCQ/AZT/Zn?
- lucd 6y agoYou personal experience, despite being very important to you, isn't significative as scientific proof. The site you mentioned is anonymous, a collection of links with arbitrary ratings. This isn't a scientific paper, this is marketing. Here is a real meta-analysis for the different covid-19 treatments: https://www.bmj.com/content/370/bmj.m2980 https://www.bmj.com/content/370/bmj.m2980 In 100% of randomized controlled trials, the most significant kind of scientific evidence, hydroxychloroquine is ineffective. https://threadreaderapp.com/thread/1291068395497062400.html https://threadreaderapp.com/thread/1291068395497062400.html
- tlb 6y agoNot a randomized trial. In fact: > Several comorbidities were significantly less frequent in the HCQ group, including cardiovascular diseases, arterial hypertension, chronic renal disease, neurological and cognitive disorders, solid cancer, obesity as well as the proportion of active smokers. IOW, doctors gave HCQ to healthier people, so you can't conclude much from the death rate being lower. There may be some value in this paper if you really dig into the details, but the overall death rate isn't a meaningful indication of whether HCQ helps.
- mmastrac 6y agoPlus once they adjusted for the multiple variables the effect is not huge. This will probably be more valuable in a much larger meta-analysis.
- WD-42 6y agoNot disagreeing with you, but you should probably include the next sentence: > patients in the HCQ group appeared to be sicker as reflected by the higher frequency of radiological pneumonia, acute respiratory distress syndrome, ICU transfer within the 24h after admission and invasive ventilation support as well as the higher frequency of elevated LDH and CRP levels. But yes, it does not look good for this study that the HCQ group tended to be younger and healthier.
- gojomo 6y agoAnd the VA observational study showing no HCQ benefit had the opposite problem, with those given HCQ much worse on many markers-of-health. Non-randomized studies have wasted a lot of everyone's attention on this & related issues.
- jdoliner 6y agohttps://c19study.com/ https://c19study.com/ This site has a good summary of all the studies that have been done on HCQ treatment of Covid-19.
- lucd 6y agoThis is a collection of links with arbitrary ratings from anonymous authors. A propaganda piece. Here is a real meta-analysis.. https://www.bmj.com/content/370/bmj.m2980 https://www.bmj.com/content/370/bmj.m2980
- jdoliner 6y agoWhat makes you say the ratings are arbitrary? Can you point to any of the papers in which the rating is out of sync with the conclusion of the linked paper?
- lucd 6y agoNo methodology, anonymous authors, no peer-reviewing, related to the account @covidanalysis, which is known to push pro-hcq propaganda.. Are you kidding? Why should we waste time with this propaganda piece while there are real scientific papers available? No methodology, anonymous authors, no peer-reviewing, related to the account @covidanalysis, which is known to push pro-hcq propaganda.. Are you kidding? Some smart French guy debunked this site https://threadreaderapp.com/thread/1284493669895041024.html https://threadreaderapp.com/thread/1284493669895041024.html And c19trials, another disinformation piece from the same authors.. https://threadreaderapp.com/thread/1291126570392924160.html https://threadreaderapp.com/thread/1291126570392924160.html
- jdoliner 6y agoI'm not sure what you're saying. Every paper has named authors listed next to it. And it explicitly states which ones have been peer-reviewed and which haven't (most, but not all, have been). Clicking through gets you full papers in the medical journals they were published in which includes the methodology.
- lucd 6y agoGroup treated with HCQ much younger and healthier..Study published in a paper were the editor-in-chief works for Raoult Institute..more of less self-publishing.. This is an obversational retrospective study.. Hydroxychloroquine is ineffective 100% of peer-reviewed randomized controlled trials,which is much more significative evidence..
- Khelavaster 6y ago> Group treated with HCQ much younger and healthier.. Younger and sicker, actually: >> patients in the HCQ group appeared to be sicker as reflected by the higher frequency of radiological pneumonia, acute respiratory distress syndrome, ICU transfer within the 24h after admission and invasive ventilation support as well as the higher frequency of elevated LDH and CRP levels.
- lucd 6y agoHealthier as less comorbidites..
- booboolayla 6y agoI hope any vaccine that comes out against COVID-19 will get the same level of scrutiny HCQ+Zinc does. But we all know it really won't, as long as it's promoted by the mainstream media. All the amateur study readers will suddenly find better things to do.
- chunsj 6y agoWhy this kind of lie keeps up?
- edgriebel 6y agoI'm sure people are going to find some link between sciencedirect.com and the Trump administration so we can ignore it, since it doesn't fit with our worldview of Orange Man Bad