bigtruckguy3500 said:
Clinical trials typically require smaller initial trials that aren't double blinded, to prove some sort of efficacy, and safety before someone determines it's worth it and safe to invest in large double blinded trials. Right now it appears that hydroxychloroquine isn't an effective treatment or prophylaxis when you factor in the risk of harms. Several studies had to stop administering the drug early due to an increase in mortality. What works in a petri dish, or even in animal studies and small scale human trials, doesn't always translate into effective in humans on a large scale. Isn't azithromycine and hydroxychloroquine both QT prolonging?
Remdesivir data is kinda weak right now, in my opinion. It has some potential as a tool, but it's no silver bullet.
Also, I know it's cool to think big pharma and hospitals and doctors get together and conspire to only use the most expensive drugs, and keep people in the hospital for as long as possible to make as much money as possible, but the recent study that shows that dexamethasone (an very cheap, generic, steroid) can reduce mortality at a number needed to treat of 8 kinda indicates it's you're probably a little paranoid.
But, as you pointed out, just because there isn't data to prove something doesn't mean it isn't true.
Thank you for the response. Can you link to the study that shows the increase in mortality due to HCQ?
The main study I have found that concludes that HCQ leads to an increase in mortality is The Lancet study. The other major study cited is the RECOVERY trial in the UK, which doesn't suggest an increase in mortality, rather it concludes there is "no clinical benefit of HCQ in hospitalized patients with COVID-19".
The Lancet Study has been proven to be flawed and has since been retracted. However, the WHO used The Lancet as justification for cancelling all of its HCQ trials. After the Lancet trial was retracted, the WHO never renewed the trials citing the ineffective results from the RECOVERY trial. Other major institutions, including the French drug maker Sanofi have also suspended their own HCQ trials following the recommendation from the WHO.
Source: WHO halts HCQ trials due to Lancet Study
https://www.npr.org/sections/coronavirus-live-updates/2020/05/25/861913688/who-halts-hydroxychloroquine-trial-over-safety-concernsSource: WHO suspends HCQ trials permanently due to RECOVERY results
https://www.who.int/news-room/q-a-detail/q-a-hydroxychloroquine-and-covid-19Source: Sanofi cancels HCQ trials after WHO recommendation
https://www.cnbc.com/2020/05/29/coronavirus-sanofi-suspends-recruitment-for-clinical-trial-testing-hydroxychloroquine.htmlThe RECOVERY Trial in the UKAll patients in RECOVERY trail in the UK were required to be hospitalized (i below). The SARS-CoV-2 infection can either be "clinically suspected or laboratory confirmed" (ii below). These are 2 major flaws with the study. The RECOVERY trial administered HCQ at an initial loading dose of 2400mg in the first 24 hours and 800 mg/day thereafter. No Zinc or Z-pack were administered. The 2400 mg loading dose is 3x higher than any recommendation from John Hopkins for HCQ dosing. And 4x higher than Dr. Raoult's Marseilles recommended treatment of 600 mg/day.
Source: RECOVERY trial protocol (also image uploaded below)
https://www.recoverytrial.net/files/recovery-protocol-v6-0-2020-05-14.pdf
Source: John Hopkins recommended HCQ dose for different disease treatements
https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540748/all/HydroxychloroquineThe anecdotal success stories suggest that HCQ+Zn+Zpak is an effective treatment to COVID-19
when administered in the early stages of the disease. The claim is that it helps reduce the speed of viral replication, which allows your immune system to better handle the virus before severe symptoms and complications develop.
This study only accepted participants that were already hospitalized. Slowing down viral replication at this stage of the disease is too little too late.
Analogy: Rabies. For a person that is bitten by an animal with rabies, a rabies shot is injected into the patient ASAP to prevent the virus from infecting the host. This needs to be done before the patient has been infected with the virus. If you wait until after the patient has developed rabies, the shot is ineffective. It cannot "undo" the infection, only prevent it. The HCQ+Zn+Zpak treatment is hypothesized to act in the same way with COVID. Applying prophylactic treatments on hospitalized patients with severe disease unsurprisingly yields ineffective results.
In regards to the second point of including "clinically suspected" COVID patients into the study. I understand that testing was limited early on, but including this inherently subjective data set into the end-all-be-all study for condemning HCQ is a design flaw in the study. Direct quote from the study protocol:
Quote:
In general, SARS-CoV-2 infection should be suspected when a patient presents with (i) typical symptoms (e.g. influenza-like illness with fever and muscle pain, or respiratory illness with cough and shortness of breath); and (ii) compatible chest X-ray findings (consolidation or ground-glass shadowing); and (iii) alternative causes have been considered unlikely or excluded (e.g. heart failure, influenza). However, the diagnosis remains a clinical one based on the opinion of the managing doctor.
TLDR: The Lancet study was used as a reason to cancel additional HCQ trials due to safety concerns. The Lancet study was then retracted due to several errors. HCQ trials still canceled despite the retraction of study used as the initial justification for trial cancellations. RECOVERY trial tests HCQ on hospitalized patients at an initial loading dose of 3-4 times higher than the recommended dose. Zinc and Z-pack are not included in the treatment protocol. The studies includes"clinically diagnosed" patients (no actual test performed) in the study, which states is based on the opinion of the managing doctor. This study has been used to definitively show the ineffectiveness of HCQ in treating COVID-19.
Disclaimer: I am not a doctor and I understand that this sounds paranoid. I have done my own research and have tried to be objective, but still, I cannot find any clinical trial that attempts to study HCQ+Zinc+Z pack as an early treatment to COVID-19. The trials I have found that are used to discredit HCQ, do not test the treatment as it is reported to be successful by anecdotal observations reported by other doctors.