5 ms·

“ Keep in mind that Hydroxychloroquine is one of the existing drugs discovered to have some effect on early infections, but it clearly failed to have much impac

“ Keep in mind that Hydroxychloroquine is one of the existing drugs discovered to have some effect on early infections, but it clearly failed to have much impact on late-stage infections” Do you mind sharing your evidence that HCQ helps with early infections? Because I know many studies that showed no benefit, for example: https://www.nejm.org/doi/full/10.1056/nejmoa2016638 https://www.nejm.org/doi/full/10.1056/nejmoa2016638 That is one of many studies.

YetAnotherNick 6y ago
Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies: https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_2020.01047/_pdf/-char/en https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_202...
- Herodotus38 6y ago
  That appears (there is no date) to be a brief paper from February or March. I’m interested in what you think that paper says? Read what the title says and read the short paper. It has zero references to results of use in patients other than referring to a news release. There is link that it is being used in clinical trials, but no results. We know HCQ does not do anything for Covid after hundreds of studies. It is time to move on. Focus on other potential treatments.
BlueTemplar 6y ago
There's a bunch of very professional-looking websites claiming the effectiveness of HCQ, especially early on : https://hcqtrial.com/ https://hcqtrial.com/ https://hcqmeta.com/ https://hcqmeta.com/ (And now https://c19study.com/ https://c19study.com/ ?) Sadly, I only have been able to find this as criticism : https://sciencebasedmedicine.org/hcqtrial-com-astroturf-and-disinformation-about-hydroxychloroquine-and-covid-19-on-steroids/ https://sciencebasedmedicine.org/hcqtrial-com-astroturf-and-...
- Herodotus38 6y ago
  EDIT: Also note that those links are all the run by the same group, the FAQs are the same. Consider reading the IDSA (Infectious Disease Society of America) guidelines. They get updated fairly regularly and are composed of the boots on the ground infectious disease specialist physicians who are trying to help people. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/ https://www.idsociety.org/practice-guideline/covid-19-guidel... Unfortunately, HCQ became politicized which added a bunch of noise. There are a lot of people who are invested in being right for various reasons rather than trying to find the truth, and many of these websites are biased. For what it's worth, I am a physician who prescribed HCQ to patients in March (with appropriate informed consent from pts/families) when he had no other idea of treatment options based on the original study which purported to show decreased viral load. It became obvious that it didn't matter whether patients got it or not in my experience (some got better and some died whether or not they got it), numerous studies then confirmed this. Most if not all hospitals were trying it with the first wave back in Jan-March and then we stopped using it when data came out that it didn't change anything. Then, things got crazy because it became promoted by certain politicians (this happened when any physician with experience had already realized it was a placebo) AND then there was a big scandal where a paper was published showing increased mortality that based on falsified data and later retracted.
  - addicted 6y ago
    What sucks most is that there are several medicines that have found to have a positive effect that got drowned in the HCQ noise.
    - Herodotus38 6y ago
      There are a lot of potential medications that are being studied and it's good to remember that we have to do good science to know what we are doing. So far, only steroids (specifically dexamethasone) has shown a mortality reduction. Remdesivir maybe decreases length of stay in the hospital. Currently beside fluvoxamine, there is research being done on colchicine (usually used for gout), ivermectin (controversial because the main people promoting it believe so strongly in it that they flat out say on their website it is unethical to perform randomized control trials to study it at this point, which is bonkers), various vitamins have been proposed.
garmaine 6y ago
The proposed mechanism for HCQ (zinc affinity) implies that it would be most effective if taken before the onset of symptoms, perhaps even before viral load is high enough to test positive. Obviously this makes it challenging to do a study. Nearly all studies that I’m aware of are initiated on patients that are already showing symptoms, because the patients are enrolled at the hospital, and few have the necessary zinc supplication. The expectation is that these studies would show little benefit, and indeed that is the case. There remains no studies with large sample sizes done as far as I know with HCQ+zinc given as a prophylactic measure immediately upon first exposure. EDIT: It's also worth mentioning that this isn't some crank theory about COVID. It is well known that zinc inhibits replication of RNA virus, giving the immune system more time to respond. I used to get colds 5-6 times a year, and the flu almost every year. When I learned about this effect zinc has, I started taking mega doses of zinc upon exposure, whether I'm close to someone known to be sick, flying through airports, or just caught in cold weather. I have not had cold or flu symptoms since I started this regimen about 2 years ago. Of course that is just an anecdote. There are, IIRC, observational studies showing this effect across larger populations.
- Herodotus38 6y ago
  Sure and when you have results of a RCT of zinc plus HCQ in prophylactic patients and publish it I will read it with great interest and if the data looks good I will be giving it to all my patients. If, however, you want to tell me that I should be using it now, because of a proposed mechanism and theoretical benefit, by using that logic why shouldn't I be giving my patients all other vitamins/supplements/medications that have been variously proposed and have their own believers? Aside from HCQ+zinc, what other cheap, low risk interventions do you propose be given and studied? (edit: additional thoughts) If you don't have any others, than I suggest you reevaluate why you think HCQ+zinc is unique (it's not). If you do, then you'll have a list of them and probably a list of reasons for each and a ranking of which are the most promising and which are the least. When you do this, it forces you to critically think about how best to rank these and how that ranking might change with evidence. Then it forces you to study the evidence. In an above post I mentioned that I did give HCQ to patients in the hospital back in March when it was the only thing that had ANY evidence (and the evidence was poor, but it was all they had). It made no difference, and it may have caused some deaths due to QTc prolongation (personally I believe it is very safe and I've taken it for malarial prophylaxis before). edit: (I removed a snarky line, apologies)

YetAnotherNick 6y ago

Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies: https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_2020.01047/_pdf/-char/en https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_202...

Herodotus38 6y ago
That appears (there is no date) to be a brief paper from February or March. I’m interested in what you think that paper says? Read what the title says and read the short paper. It has zero references to results of use in patients other than referring to a news release. There is link that it is being used in clinical trials, but no results. We know HCQ does not do anything for Covid after hundreds of studies. It is time to move on. Focus on other potential treatments.

BlueTemplar 6y ago

There's a bunch of very professional-looking websites claiming the effectiveness of HCQ, especially early on : https://hcqtrial.com/ https://hcqtrial.com/ https://hcqmeta.com/ https://hcqmeta.com/ (And now https://c19study.com/ https://c19study.com/ ?) Sadly, I only have been able to find this as criticism : https://sciencebasedmedicine.org/hcqtrial-com-astroturf-and-disinformation-about-hydroxychloroquine-and-covid-19-on-steroids/ https://sciencebasedmedicine.org/hcqtrial-com-astroturf-and-...

Herodotus38 6y ago
EDIT: Also note that those links are all the run by the same group, the FAQs are the same. Consider reading the IDSA (Infectious Disease Society of America) guidelines. They get updated fairly regularly and are composed of the boots on the ground infectious disease specialist physicians who are trying to help people. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/ https://www.idsociety.org/practice-guideline/covid-19-guidel... Unfortunately, HCQ became politicized which added a bunch of noise. There are a lot of people who are invested in being right for various reasons rather than trying to find the truth, and many of these websites are biased. For what it's worth, I am a physician who prescribed HCQ to patients in March (with appropriate informed consent from pts/families) when he had no other idea of treatment options based on the original study which purported to show decreased viral load. It became obvious that it didn't matter whether patients got it or not in my experience (some got better and some died whether or not they got it), numerous studies then confirmed this. Most if not all hospitals were trying it with the first wave back in Jan-March and then we stopped using it when data came out that it didn't change anything. Then, things got crazy because it became promoted by certain politicians (this happened when any physician with experience had already realized it was a placebo) AND then there was a big scandal where a paper was published showing increased mortality that based on falsified data and later retracted.
- addicted 6y ago
  What sucks most is that there are several medicines that have found to have a positive effect that got drowned in the HCQ noise.
  - Herodotus38 6y ago
    There are a lot of potential medications that are being studied and it's good to remember that we have to do good science to know what we are doing. So far, only steroids (specifically dexamethasone) has shown a mortality reduction. Remdesivir maybe decreases length of stay in the hospital. Currently beside fluvoxamine, there is research being done on colchicine (usually used for gout), ivermectin (controversial because the main people promoting it believe so strongly in it that they flat out say on their website it is unethical to perform randomized control trials to study it at this point, which is bonkers), various vitamins have been proposed.

garmaine 6y ago

The proposed mechanism for HCQ (zinc affinity) implies that it would be most effective if taken before the onset of symptoms, perhaps even before viral load is high enough to test positive. Obviously this makes it challenging to do a study. Nearly all studies that I’m aware of are initiated on patients that are already showing symptoms, because the patients are enrolled at the hospital, and few have the necessary zinc supplication. The expectation is that these studies would show little benefit, and indeed that is the case. There remains no studies with large sample sizes done as far as I know with HCQ+zinc given as a prophylactic measure immediately upon first exposure. EDIT: It's also worth mentioning that this isn't some crank theory about COVID. It is well known that zinc inhibits replication of RNA virus, giving the immune system more time to respond. I used to get colds 5-6 times a year, and the flu almost every year. When I learned about this effect zinc has, I started taking mega doses of zinc upon exposure, whether I'm close to someone known to be sick, flying through airports, or just caught in cold weather. I have not had cold or flu symptoms since I started this regimen about 2 years ago. Of course that is just an anecdote. There are, IIRC, observational studies showing this effect across larger populations.

Herodotus38 6y ago
Sure and when you have results of a RCT of zinc plus HCQ in prophylactic patients and publish it I will read it with great interest and if the data looks good I will be giving it to all my patients. If, however, you want to tell me that I should be using it now, because of a proposed mechanism and theoretical benefit, by using that logic why shouldn't I be giving my patients all other vitamins/supplements/medications that have been variously proposed and have their own believers? Aside from HCQ+zinc, what other cheap, low risk interventions do you propose be given and studied? (edit: additional thoughts) If you don't have any others, than I suggest you reevaluate why you think HCQ+zinc is unique (it's not). If you do, then you'll have a list of them and probably a list of reasons for each and a ranking of which are the most promising and which are the least. When you do this, it forces you to critically think about how best to rank these and how that ranking might change with evidence. Then it forces you to study the evidence. In an above post I mentioned that I did give HCQ to patients in the hospital back in March when it was the only thing that had ANY evidence (and the evidence was poor, but it was all they had). It made no difference, and it may have caused some deaths due to QTc prolongation (personally I believe it is very safe and I've taken it for malarial prophylaxis before). edit: (I removed a snarky line, apologies)