Randomized HCQ Trail Results Coming In

3,452 Views | 35 Replies | Last: 5 yr ago by TRADUCTOR
Snap E Tom
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2:18p, 3/30/20
Yes, it works.

https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v1

No more excuses about efficacy, no more excuses about papers thus far being non-randomized, no more excuses about tragic side effects. Sorry, y'all are going to have to go back to work soon.
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FriscoKid
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2:23p, 3/30/20
AG
Quote:
Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia.
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Infection_Ag11
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2:25p, 3/30/20
AG
I hope it does work, but that's a pretty flawed study of only 62 patients that hasn't even been peer reviewed yet. Not exactly TIMI level stuff there.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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thelaw4
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2:26p, 3/30/20
AG
Great news! Could this become like tamiflu? You go to the doctor, get tested, get your HCQ, recover and we can all move on with life.
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MACnolaAg
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2:27p, 3/30/20
AG
Why should we trust this? I think it raises questions that (1) at the height of the Chinese response (2) in the epicenter of the pandemic that (3) a research hospital only ends up with 62 cases?

I don't see how that all adds up. And if the answer is that the 62 selected patients were the only ones in this randomized treatment protocol, well that doesn't necessarily seem so random after all.

So I'm not an expert by any means, but color me a little skeptical here.
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Milwaukees Best Light
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2:27p, 3/30/20
Infection_Ag11
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In reply to Snap E Tom • 2:28p, 3/30/20
AG
And the average age of 44 really calls into question the practical clinical usefulness of this study regardless of the validity of the data itself.
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JB99
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2:29p, 3/30/20
AG
It's already being widely used with mixed results.
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VaultingChemist
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In reply to JB99 • 2:38p, 3/30/20
AG
JB99 said:
It's already being widely used with mixed results.
It appears that the earlier that HCQ is provided, the better the clinical outcome. This should not be a surprise, since HCQ efficacy is from slowing viral replication. Quick and accurate testing will probably be a crucial component in optimizing treatment.
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ham98
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In reply to VaultingChemist • 2:45p, 3/30/20
VaultingChemist said:
JB99 said:
It's already being widely used with mixed results.
It appears that the earlier that HCQ is provided, the better the clinical outcome. This should not be a surprise, since HCQ efficacy is from slowing viral replication. Quick and accurate testing will probably be a crucial component in optimizing treatment.
We may have a supply issue if we want to use it en masse for patients in early phase of the disease
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Snap E Tom
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In reply to Infection_Ag11 • 2:49p, 3/30/20
Infection_Ag11 said:
I hope it does work, but that's a pretty flawed study of only 62 patients that hasn't even been peer reviewed yet. Not exactly TIMI level stuff there.
You know when n increases, chances of Type I errors increase. 62 is perfectly reasonable, and the old school rule of 36 still gets at least a nod from statisticians.
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KidDoc
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2:49p, 3/30/20
AG
Lots of problems with this study. My clinic is super slow so I'll pick it apart:

1) 62 patients average age 44- talk about cherry picking a small number of patients that have a 99+% chance of getting better no matter what you do.

2) In the control 55% had "improved pneumonia" (not resolved? Not sure exactly what that means) and 80% in the treatment group. Yes that is an improvement but again, is it significant when comparing 30 patients per group? Hard to know.

3) The final statement is what we really want to know and hopefully will be replicated with larger studies of higher risk patients: " Notably, all 4 patients progressed to severe illness that occurred in the control group. "
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Infection_Ag11
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In reply to Snap E Tom • 4:03p, 3/30/20
AG
Snap E Tom said:
Infection_Ag11 said:
I hope it does work, but that's a pretty flawed study of only 62 patients that hasn't even been peer reviewed yet. Not exactly TIMI level stuff there.
You know when n increases, chances of Type I errors increase. 62 is perfectly reasonable, and the old school rule of 36 still gets at least a nod from statisticians.


Sure, but statistical power carries a lot of weight in the practice of evidence based medicine.

The most glaring issue is the average age of 44. That almost 25 years younger than the average patient admitted for COVID. It's just not a representative sample.
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PneumAg
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In reply to Infection_Ag11 • 4:05p, 3/30/20
Infection_Ag11 said:
I hope it does work, but that's a pretty flawed study of only 62 patients that hasn't even been peer reviewed yet. Not exactly TIMI level stuff there.


So what?
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buffalo chip
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4:12p, 3/30/20
S
Interesting...
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TRADUCTOR
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4:12p, 3/30/20
Thread rename request: THE MEDICAL THUNDERDOME
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OldArmy71
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4:18p, 3/30/20
AG
I hope it does work, but there are at least two doctors on this board who are actually treating COVID patients and they do not think the drug cocktail is very helpful, though they are using it anyway.
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HotardAg07
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4:18p, 3/30/20
AG
The death rate by age graph:


As you can see, the 40-49 age group death rate has been 0.1% to 0.6% of confirmed cases. Therefore, in a group of 62 people from that age group, it would be almost as likely as not that there would be a fatality.

I saw that the French study which only included 26 people actually kicked results out of the study who had to go to the ICU or died, since they couldn't complete the duration of the testing.

I think it's these reasons why it's important to keep a skeptical eye on these things.
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abram97
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In reply to PneumAg • 4:19p, 3/30/20
AG
PneumAg said:
Infection_Ag11 said:
I hope it does work, but that's a pretty flawed study of only 62 patients that hasn't even been peer reviewed yet. Not exactly TIMI level stuff there.


So what?
It does not meet the standards for med peeps in the least. Standards are high since dealing with people's lives.

In light of what is going on though, it is at least something and it is a hypothesis generating find.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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bay fan
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In reply to VaultingChemist • 4:22p, 3/30/20
S
VaultingChemist said:
JB99 said:
It's already being widely used with mixed results.
It appears that the earlier that HCQ is provided, the better the clinical outcome. This should not be a surprise, since HCQ efficacy is from slowing viral replication. Quick and accurate testing will probably be a crucial component in optimizing treatment.
What of the people that depend on this for auto immune diseases that can't get something proven to be effective for them they depend upon?

Personally, I think those people should have priority prescriptions.
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74Ag1
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4:25p, 3/30/20
AG
Why wasn't Zinc and the antibiotic used also?
I thought the Hydro opened the cell wall and the Zinc and antibiotic killed it.
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Infection_Ag11
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In reply to PneumAg • 4:31p, 3/30/20
AG
PneumAg said:
Infection_Ag11 said:
I hope it does work, but that's a pretty flawed study of only 62 patients that hasn't even been peer reviewed yet. Not exactly TIMI level stuff there.


So what?


So this is a field defined by evidence based practice, and this doesn't represent high quality evidence.
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Infection_Ag11
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In reply to 74Ag1 • 4:32p, 3/30/20
AG
74Ag1 said:
Why wasn't Zinc and the antibiotic used also?
I thought the Hydro opened the cell wall and the Zinc and antibiotic killed it.


Azithromycin is being given as prophylaxis against bacterial superinfection, and I've outlined previously on here why I don't think it's a good idea.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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OldArmy71
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4:38p, 3/30/20
AG
My understanding was that the Z pack has some anti-viral, anti-inflammatory abilities, and has been used in COPD I think.
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G Martin 87
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4:39p, 3/30/20
AG
This thread is evidence of the value of the verified doctor tag.
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OldArmy71
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In reply to G Martin 87 • 4:43p, 3/30/20
AG
Boy, you got that right!
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Ranger222
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In reply to 74Ag1 • 4:50p, 3/30/20
AG
74Ag1 said:
Why wasn't Zinc and the antibiotic used also?
I thought the Hydro opened the cell wall and the Zinc and antibiotic killed it.


"Opened the cell wall" is not the proposed mechanism of action for hydroxychloroquine
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BigOil
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4:51p, 3/30/20
AG
Literally the second sentence in the Abstract: "However, evidence regarding its effects in patients is limited."
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Ranger222
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4:51p, 3/30/20
AG
Also per the TWiV podcast I linked earlier today, one system of NYC hospitals is reducing hydroxychloroquine use as it doesn't seem to make a difference
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Infection_Ag11
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In reply to OldArmy71 • 4:52p, 3/30/20
AG
OldArmy71 said:
My understanding was that the Z pack has some anti-viral, anti-inflammatory abilities, and has been used in COPD I think.


The anti-inflammatory effects have really only ever been demonstrated in acute exacerbations of chronic lung disease.

Outside of that, it's more or less medical voodoo
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2PacShakur
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5:03p, 3/30/20
AG
Though yes, the selection of the age group is important, their selection of more middle age patients is OK. Their first exclusion criteria is literally severe and critically ill patients that they're not sure will benefit the patient. Think of a Hill Slope, you may want a patient group that's in the middle of the slope so you can measure improvements or worsening conditions within a (short) time period. If you're on the severe end or extreme end of the slope, it may be more difficult to collect an "improvement" within a week's period as defined within the protocol. In oncology, you would include a more diverse set of patients but stratify them by disease stage or some kind of prognostic index so in effect something similar.

I do not know if their endpoints are clinically significant to C19 being a new disease/field. Their primary endpoint is defined by body temperature and coughing relief maintained for a 72 hour period (degree of coughing could be a little subjective too, almost like a visual analog scale). An overall survival measurement would probably provide more of a "gold" standard and be more clinically relevant for what patients want to know (that is, what are my chance I will survive) but that is a longer time frame. The chest CT data is nice, where 50%+ is significant reduction presumably in the surface area of a CT readout and moderate is less than that (it doesn't define the lower bound criteria for "moderate".)
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PneumAg
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In reply to abram97 • 5:20p, 3/30/20
abram97 said:
PneumAg said:
Infection_Ag11 said:
I hope it does work, but that's a pretty flawed study of only 62 patients that hasn't even been peer reviewed yet. Not exactly TIMI level stuff there.


So what?
It does not meet the standards for med peeps in the least. Standards are high since dealing with people's lives.

In light of what is going on though, it is at least something and it is a hypothesis generating find.


Every doctor I've talked to is in favor of lockdowns and other absurd economic measures without any clue what the short-term or long-term effects will be. Yet they pick apart every study of HCQ and say it shouldn't be widely used for the Chinese virus until proven beyond a shadow of a doubt to be effective with minimal side effects. The logical inconsistency is disturbing.
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Infection_Ag11
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In reply to PneumAg • 5:29p, 3/30/20
AG
PneumAg said:
abram97 said:
PneumAg said:
Infection_Ag11 said:
I hope it does work, but that's a pretty flawed study of only 62 patients that hasn't even been peer reviewed yet. Not exactly TIMI level stuff there.


So what?
It does not meet the standards for med peeps in the least. Standards are high since dealing with people's lives.

In light of what is going on though, it is at least something and it is a hypothesis generating find.


Every doctor I've talked to is in favor of lockdowns and other absurd economic measures without any clue what the short-term or long-term effects will be. Yet they pick apart every study of HCQ and say it shouldn't be widely used for the Chinese virus until proven beyond a shadow of a doubt to be effective with minimal side effects. The logical inconsistency is disturbing.


This is a gross misrepresentation of what just about every physician here and the politics board has said.
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74Ag1
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In reply to Infection_Ag11 • 6:16p, 3/30/20
AG
Infection_Ag11 said:
74Ag1 said:
Why wasn't Zinc and the antibiotic used also?
I thought the Hydro opened the cell wall and the Zinc and antibiotic killed it.


Azithromycin is being given as prophylaxis against bacterial superinfection, and I've outlined previously on here why I don't think it's a good idea.

Thanks
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In reply to PneumAg • 6:28p, 3/30/20
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