Huh? Even docs are saying no to this. Are they pseudoscientists too?
Hydroxychloroquine...........
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Last: 9 mo ago by Jabin
I mean, there's also actual doctors doing trials with mixed results.Strike One said:
Use Hydroxyclorophine or not? Sounds like there are two distinct camps on this: Liberal/democrat/psuedoscientists vs. conservative/practical/physicians in the field. I know which camp I'm in and which one I trust more. Besides, I always prefer optimism and hope rather than gloom and doom from people who do not know the truth but are darn sure convinced they do!
Scrolled through the study on my phone. Just kind of a (very) rapid critical analysis.
Retrospective chart reviews are generally decent evidence, but they are still not RCTs. Just like the previous study with the VA patients, we don't know how truly sick some of the people were or how far along in the disease process they were when they got the medication. We know that they excluded patients already on vents, but we don't know how far away from needing a vent that a lot of these patients were.
The dataset only included people with a positive PCR swab, but the dataset goes all the way back to December, long before we had widespread testing anywhere. In the United States throughout pretty much the entire months of February and March it was taking up to a week or longer to get test results. People were not even getting tests until they had been symptomatic for 5 to 7 days and needed hospitalization. Add the several days for the test results to come back for many of these patients and you have people who were nearing the phase of cytokine storm before they were even started on it. Would have really liked to see the data broken down by date of symptoms to see if earlier diagnosis/treatment start had any effect.
That being said, I think their conclusion makes sense. Given how we know azithromycin and hydroxychloroquine can widen the QTc and make people more prone to ventricular arrhythmias, and given we know that people with covid-19 (and many acute lung conditions in general) are already seeming to be more prone to these events, it would make complete sense that when given the risks for arrythmias would go up. These meds basically stack the deck for these things to happen when the body is under stress.
Outpatient setting is completely different.
What we don't know yet and what we have curious little data on is how effective hydroxychloroquine with zinc is when given much earlier in the disease process and/or prophylactically. If the mechanism of action is being simply a zinc transporter and doesn't have an effect on the inflammatory process, there are plenty of other medications and supplements that are safer and can serve the same purpose. This is the data we need.
Retrospective chart reviews are generally decent evidence, but they are still not RCTs. Just like the previous study with the VA patients, we don't know how truly sick some of the people were or how far along in the disease process they were when they got the medication. We know that they excluded patients already on vents, but we don't know how far away from needing a vent that a lot of these patients were.
The dataset only included people with a positive PCR swab, but the dataset goes all the way back to December, long before we had widespread testing anywhere. In the United States throughout pretty much the entire months of February and March it was taking up to a week or longer to get test results. People were not even getting tests until they had been symptomatic for 5 to 7 days and needed hospitalization. Add the several days for the test results to come back for many of these patients and you have people who were nearing the phase of cytokine storm before they were even started on it. Would have really liked to see the data broken down by date of symptoms to see if earlier diagnosis/treatment start had any effect.
That being said, I think their conclusion makes sense. Given how we know azithromycin and hydroxychloroquine can widen the QTc and make people more prone to ventricular arrhythmias, and given we know that people with covid-19 (and many acute lung conditions in general) are already seeming to be more prone to these events, it would make complete sense that when given the risks for arrythmias would go up. These meds basically stack the deck for these things to happen when the body is under stress.
Outpatient setting is completely different.
What we don't know yet and what we have curious little data on is how effective hydroxychloroquine with zinc is when given much earlier in the disease process and/or prophylactically. If the mechanism of action is being simply a zinc transporter and doesn't have an effect on the inflammatory process, there are plenty of other medications and supplements that are safer and can serve the same purpose. This is the data we need.
Yeah, before you know it one of these pseudoscientists is going to have the temerity to say that the earth actually revolves around the sun.Charpie said:
Huh? Even docs are saying no to this. Are they pseudoscientists too?
I believe there is a Univ Of Minnesota RPCT trial coming out soon. Holding judgement.
"Our study has several limitations. The association of decreased survival with hydroxychloroquine or chloroquine treatment regimens should be interpreted cautiously. Due to the observational study design, we cannot exclude the possibility of unmeasured confounding factors, although we have reassuringly noted consistency between the primary analysis and the propensity score matched analyses. Nevertheless, a cause-and-effect relationship between drug therapy and survival should not be inferred. These data do not apply to the use of any treatment regimen used in the ambulatory, out-of-hospital setting. Randomised clinical trials will be required before any conclusion can be reached regarding benefit or harm of these agents in COVID-19 patients. We also note that although we evaluated the relationship of the drug treatment regimens with the occurrence of ventricular arrhythmias, we did not measure QT intervals, nor did we stratify the arrhythmia pattern (such as torsade de pointes). "
The above is from the study. I really don't know the value of these after the fact observational studies. I read the article to determine the definition of ventricular arrythmias. No such definition exist that I can find. I have bolded the cardiac limitations. What are they counting, PVC's?? They didn't measure QT and more importantly they did not identify Torsades, which is what matters. Regardless of whether or not these drugs help hospitalized patients with COVID 19, throwing out "data" like this make you wonder why similar findings are not observed in Malaria or rheumatology patients if they are proposing HCQ as an independent predictor of death.
This stuff is disappointing in my opinion. At this point only a randomized clinical trial of any Covid 19 drug should be presented. No need for for more academic guys to generate articles for their CV.
The above is from the study. I really don't know the value of these after the fact observational studies. I read the article to determine the definition of ventricular arrythmias. No such definition exist that I can find. I have bolded the cardiac limitations. What are they counting, PVC's?? They didn't measure QT and more importantly they did not identify Torsades, which is what matters. Regardless of whether or not these drugs help hospitalized patients with COVID 19, throwing out "data" like this make you wonder why similar findings are not observed in Malaria or rheumatology patients if they are proposing HCQ as an independent predictor of death.
This stuff is disappointing in my opinion. At this point only a randomized clinical trial of any Covid 19 drug should be presented. No need for for more academic guys to generate articles for their CV.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
I think studies like these are important for a situation like this where evidence is scant until rct's with enough power can be done. Appears well done. If I read correctly, the study doesn't tell us how early in the illness treatment started, just patients who had been diagnosed within 48 hours or less. The study group also was significantly sicker set of people with numerous significant comorbidities than you would see most frequently in ambulatory centers. So you can't completely generalize to generally healthy patients that start the therapy within say 2 days of symptoms treated in a clinic setting. Otoh, especially in the case of plaquenil and azithro with an OR of 3.2 and NNH of 7 for death shouldn't be ignored, at least until we have powered rct's that say differently. I'm unlikely to use it for now.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
From Dr. Coates posts.
More information on Hydroxychloroquine for prophylaxis of Covid-19?
"In Mumbai they decided to offer all police officers over 40 hydroxychloroquine for prophylaxis of Covid-19. Out of 10,000 police officers 4,500 choose to go ahead and use the hydroxychloroquine. So far 618 officers who refused treatment have contracted Covid-19 and unfortunately 9 have since died from Covid-19. In the HCQ group none have died they did say a few have contracted the disease but had only very mild symptoms. There has been no reported side effects in the treatment group. Once again this is technically anecdotal information but looks promising."
More information on Hydroxychloroquine for prophylaxis of Covid-19?
"In Mumbai they decided to offer all police officers over 40 hydroxychloroquine for prophylaxis of Covid-19. Out of 10,000 police officers 4,500 choose to go ahead and use the hydroxychloroquine. So far 618 officers who refused treatment have contracted Covid-19 and unfortunately 9 have since died from Covid-19. In the HCQ group none have died they did say a few have contracted the disease but had only very mild symptoms. There has been no reported side effects in the treatment group. Once again this is technically anecdotal information but looks promising."
Anecdotally I asked my ER doc neighbor what he and his band of brothers/sisters are doing. HCQ and AZ but early in the infection.
And I think that's the key. Take it EARLY
Charpie said:
And I think that's the key. Take it EARLY
I agree with you.
So the Indians are just lying?
PJYoung said:BallerStaf2003 said:
The risk of mortality is increased 30-40% in this retrospective review of over 90,000 patients!
That is a huge risk!
For a board that talks about how minor coronavirus is, even if Hydroxychloroquine did work, the risk far outweighs the benefits.
It's being reported today that the data behind the huge Lancet study that the WHO is using as proof that HCQ doesn't work is based on falsified data.
https://www.theguardian.com/science/2020/may/28/questions-raised-over-hydroxychloroquine-study-which-caused-who-to-halt-trials-for-covid-19
The sourcing of the data is a company called Surgisphere. Australia called out their data as reported by the study as inaccurate, and now other countries are doing the same.
Surgisphere is refusing to provide its data to those calling into question its numbers.
Also look up @JamesTodaroMD on twitter, he's got several data breakouts showing the data from North America that is cited by Surgisphere and the authors of the Lancet paper is wrong.
Quote:
Why?' El Salvador's Bukele says world leaders being told to take hydroxychloroquine, while public is warned away from it
https://nationalpost.com/news/world/why-el-salvadors-bukele-says-world-leaders-being-told-to-take-hydroxychloroquine-while-public-is-warned-away-from-it
Quote:
"I use it as a prophylaxis, President Trump uses it as a prophylaxis, most of the world's leaders use it as a prophylaxis," Bukele said.
On Wednesday, in a follow-up tweet, he said:
"Does it work? I don't know. But we have been advised to take it. While the rest of the world is being advised not to. Why? That's a question worth asking. Isn't it?"
[Political comments are not wanted on this forum. -Staff]
"Of the 172 cases and 193 controls reporting HCQ intake, no significant difference in the occurrence of adverse drug reactions was noted."
Adding to the HCQ anecdotal evidence pile:
Just spoke to a couple who live across the way from our hunting lodge in E TX who both caught COVID19. Both are early 70s. Husband delayed seeing doctor until day 5-7 of symptom onset and his doc started him on HCQ. His symptoms lasted about two weeks but he was never hospitalized. Tough to read much into this either way, although it's possible it helped keep him out of hospital.
Wife started HCQ very early, on the first day she was symptomatic. Doc did not wait for a positive test for her, but she did later get a positive result. She experienced some fairly minor breathing/respiratory issues but nothing too serious, and all symptoms were gone in 5 days. I'd call that some additional support for the notion of HCQ effectiveness if started early.
Just spoke to a couple who live across the way from our hunting lodge in E TX who both caught COVID19. Both are early 70s. Husband delayed seeing doctor until day 5-7 of symptom onset and his doc started him on HCQ. His symptoms lasted about two weeks but he was never hospitalized. Tough to read much into this either way, although it's possible it helped keep him out of hospital.
Wife started HCQ very early, on the first day she was symptomatic. Doc did not wait for a positive test for her, but she did later get a positive result. She experienced some fairly minor breathing/respiratory issues but nothing too serious, and all symptoms were gone in 5 days. I'd call that some additional support for the notion of HCQ effectiveness if started early.
Did they also receive Zithromax? Did they take zinc?
More info about Surgisphere.
Their data was used in two other studies that are now in question. One claimed ACE inhibitors did not increase mortality and one claimed Ivermectin was effective.
https://www.sciencemag.org/news/2020/06/mysterious-company-s-coronavirus-papers-top-medical-journals-may-be-unraveling
Their data was used in two other studies that are now in question. One claimed ACE inhibitors did not increase mortality and one claimed Ivermectin was effective.
https://www.sciencemag.org/news/2020/06/mysterious-company-s-coronavirus-papers-top-medical-journals-may-be-unraveling
Just published an hour ago.
https://www.nejm.org/doi/full/10.1056/NEJMoa2016638?query=featured_home
A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19
https://www.nejm.org/doi/full/10.1056/NEJMoa2016638?query=featured_home
A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19
Quote:
Abstract
BACKGROUND
Coronavirus disease 2019 (Covid-19) occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For persons who are exposed, the standard of care is observation and quarantine. Whether hydroxychloroquine can prevent symptomatic infection after SARS-CoV-2 exposure is unknown.
METHODS
We conducted a randomized, double-blind, placebo-controlled trial across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis. We enrolled adults who had household or occupational exposure to someone with confirmed Covid-19 at a distance of less than 6 ft for more than 10 minutes while wearing neither a face mask nor an eye shield (high-risk exposure) or while wearing a face mask but no eye shield (moderate-risk exposure). Within 4 days after exposure, we randomly assigned participants to receive either placebo or hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 additional days). The primary outcome was the incidence of either laboratory-confirmed Covid-19 or illness compatible with Covid-19 within 14 days.
RESULTS
We enrolled 821 asymptomatic participants. Overall, 87.6% of the participants (719 of 821) reported a high-risk exposure to a confirmed Covid-19 contact. The incidence of new illness compatible with Covid-19 did not differ significantly between participants receiving hydroxychloroquine (49 of 414 [11.8%]) and those receiving placebo (58 of 407 [14.3%]); the absolute difference was 2.4 percentage points (95% confidence interval, 7.0 to 2.2; P=0.35). Side effects were more common with hydroxychloroquine than with placebo (40.1% vs. 16.8%), but no serious adverse reactions were reported.
CONCLUSIONS
After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Whoops!
Quote:
At a press conference on Wednesday, the WHO announced it would resume its global trial of hydroxychloroquine, after its data safety monitoring committee found there was no increased risk of death for Covid patients taking it.
Dr. Not Yet Dr. Ag said:
Just published an hour ago.
https://www.nejm.org/doi/full/10.1056/NEJMoa2016638?query=featured_home
A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19Quote:
Abstract
BACKGROUND
Coronavirus disease 2019 (Covid-19) occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For persons who are exposed, the standard of care is observation and quarantine. Whether hydroxychloroquine can prevent symptomatic infection after SARS-CoV-2 exposure is unknown.
METHODS
We conducted a randomized, double-blind, placebo-controlled trial across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis. We enrolled adults who had household or occupational exposure to someone with confirmed Covid-19 at a distance of less than 6 ft for more than 10 minutes while wearing neither a face mask nor an eye shield (high-risk exposure) or while wearing a face mask but no eye shield (moderate-risk exposure). Within 4 days after exposure, we randomly assigned participants to receive either placebo or hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 additional days). The primary outcome was the incidence of either laboratory-confirmed Covid-19 or illness compatible with Covid-19 within 14 days.
RESULTS
We enrolled 821 asymptomatic participants. Overall, 87.6% of the participants (719 of 821) reported a high-risk exposure to a confirmed Covid-19 contact. The incidence of new illness compatible with Covid-19 did not differ significantly between participants receiving hydroxychloroquine (49 of 414 [11.8%]) and those receiving placebo (58 of 407 [14.3%]); the absolute difference was 2.4 percentage points (95% confidence interval, 7.0 to 2.2; P=0.35). Side effects were more common with hydroxychloroquine than with placebo (40.1% vs. 16.8%), but no serious adverse reactions were reported.
CONCLUSIONS
After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.
The potential window of benefit is getting smaller and smaller as more studies roll in. Not effective for prophylaxis, not effective in hospitalized patients, not effective with any evidence of pneumonia.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Thanks for posting.
Disappointing to hear. I don't understand the huge disparity in reports, positive vs negative.
Disappointing to hear. I don't understand the huge disparity in reports, positive vs negative.
OldArmy71 said:
Thanks for posting.
Disappointing to hear. I don't understand the huge disparity in reports, positive vs negative.
There's only a disparity in terms of the volume, not of the quality. The quality evidence from well designed studies has been overwhelmingly negative with regards to the efficacy of HCQ. Much of the rest are internet anecdotes, case reports and underpowered studies that changed their criteria and endpoints during the study.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
How much of a concern should there be over this part of the study:
"Adherence among the trial participants was moderate. Full adherence to the trial intervention differed according to trial group, with 75.4% of participants in the hydroxychloroquine group (312 of 414) and 82.6% of those in the placebo group (336 of 407) having taken all 19 prescribed tablets over a period of 5 days (P=0.01). "
So 25% of the treatment group didn't take the full course.
"Adherence among the trial participants was moderate. Full adherence to the trial intervention differed according to trial group, with 75.4% of participants in the hydroxychloroquine group (312 of 414) and 82.6% of those in the placebo group (336 of 407) having taken all 19 prescribed tablets over a period of 5 days (P=0.01). "
So 25% of the treatment group didn't take the full course.
That is typical of almost any RCT. Intention to treat analysis is important because it gives us real world data on the number of patients that are actually taking the drug we would be rx'ing them. As you can see, there is a significant difference in patients taking HCQ which is likely related to them having higher rates of minor side effects as was also demonstrated in the study. If a drug is 100% effective, but only 1% of patients actually take it because they cannot tolerate the side effects, then the drug is not 100% effective in real world conditions. Regardless, even with a per protocol analysis, from my understanding, there was still no significant difference in outcomes.Snap E Tom said:
How much of a concern should there be over this part of the study:
"Adherence among the trial participants was moderate. Full adherence to the trial intervention differed according to trial group, with 75.4% of participants in the hydroxychloroquine group (312 of 414) and 82.6% of those in the placebo group (336 of 407) having taken all 19 prescribed tablets over a period of 5 days (P=0.01). "
So 25% of the treatment group didn't take the full course.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Not to beat a dead horse, but wasnt HCQ claimed to be affective with Zinc or Z-pack? This study is just HCQ?Infection_Ag11 said:Dr. Not Yet Dr. Ag said:
Just published an hour ago.
https://www.nejm.org/doi/full/10.1056/NEJMoa2016638?query=featured_home
A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19Quote:
Abstract
BACKGROUND
Coronavirus disease 2019 (Covid-19) occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For persons who are exposed, the standard of care is observation and quarantine. Whether hydroxychloroquine can prevent symptomatic infection after SARS-CoV-2 exposure is unknown.
METHODS
We conducted a randomized, double-blind, placebo-controlled trial across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis. We enrolled adults who had household or occupational exposure to someone with confirmed Covid-19 at a distance of less than 6 ft for more than 10 minutes while wearing neither a face mask nor an eye shield (high-risk exposure) or while wearing a face mask but no eye shield (moderate-risk exposure). Within 4 days after exposure, we randomly assigned participants to receive either placebo or hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 additional days). The primary outcome was the incidence of either laboratory-confirmed Covid-19 or illness compatible with Covid-19 within 14 days.
RESULTS
We enrolled 821 asymptomatic participants. Overall, 87.6% of the participants (719 of 821) reported a high-risk exposure to a confirmed Covid-19 contact. The incidence of new illness compatible with Covid-19 did not differ significantly between participants receiving hydroxychloroquine (49 of 414 [11.8%]) and those receiving placebo (58 of 407 [14.3%]); the absolute difference was 2.4 percentage points (95% confidence interval, 7.0 to 2.2; P=0.35). Side effects were more common with hydroxychloroquine than with placebo (40.1% vs. 16.8%), but no serious adverse reactions were reported.
CONCLUSIONS
After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.
The potential window of benefit is getting smaller and smaller as more studies roll in. Not effective for prophylaxis, not effective in hospitalized patients, not effective with any evidence of pneumonia.
The Z pack proposed method of action is as an anti-inflammatory. The prophylactic was related to HCQ, not Z pack.
At this point, why should we believe any study?
https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine
https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine
Science is doing what science does. In this case, scientists are stepping up to oppose fraudulent manufacturered data sets.rayneag said:
At this point, why should we believe any study?
https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-who-world-health-organization-hydroxychloroquine
Part of the purpose of publishing research is so that others can verify or refute that research.
I'm reminded of an old saying often attributed to Ben Franklin: "Only believe half of what you read, and none of what you hear."
"We all entered this collaboration to contribute in good faith and at a time of great need during the COVID-19 pandemic," three of the authors wrote in their retraction for The Lancet. "We deeply apologize to you, the editors, and the journal readership for any embarrassment or inconvenience that this may have caused."
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