Posted on 03/29/2020 10:58:40 AM PDT by Widget Jr
An old malaria medicine, hydroxychloroquine, has gone viral on the internet. But is it really an antiviral drug?
The medicine has been seen as a potential treatment for Covid-19, the disease caused by the novel coronavirus SARS-CoV-2, almost since outbreaks started. This week it made headlines, due in part to tweets from President Trump and in part because of a small French study of 42 patients that seemed to show that hydroxychloroquine, particularly when combined with the antibiotic azithromycin, helped decrease patients’ levels of coronavirus. Unfortunately, the rumors about the drug’s efficacy have also encouraged some to buy and even consume a similarly named fish tank cleaner; one person has died.
But a second study emerged last week from Shanghai University in China of 30 patients hospitalized for Covid-19. Whether patients received hydroxychloroquine or not, their body temperature returned to normal a day after hospitalization, and the time it took for levels of the virus to become undetectable was comparable. Unlike the study from France, the patients in this study were randomly assigned to either hydroxychloroquine or the control group, which makes the results more reliable.
Jun Chen, one of the authors of the Shanghai study, called the French study’s results “interesting” but said they needed to be evaluated in another randomized study.
“Both our study and theirs had many limitations,” Chen wrote. “But personally, I would say that hydroxychloroquine was not a ‘magic’ drug, if there is any antiviral effect. And in fact, hydroxychloroquine has never been effective in any viral diseases, despite its in vitro antiviral activity.” “In vitro antiviral activity” means that the drug stops the virus from infecting cells in the dish.
The first mention of the Shanghai study came from a paper in The Lancet Global Health, where the results were described as positive. One of the authors of the Lancet paper, Oriol Mitjà, wrote via email that changes on CT scans showed “that the drug has some efficacy” against Covid-19. In the Shanghai study, worsening of the disease that could be picked up on a CT scan happened in 33% of those on hydroxychloroquine (that’s 5 patients) versus 47% of those in the control group (7 patients).
Mitjà was even more optimistic about the French study, saying it has “new and stronger data.”
But objections have been raised to the French study paper, even as it’s bounced around the Internet. Fox host Sean Hannity even shared another doctor’s letter on his experience using the hydroxychloroquine/azithromycin combination on his television show on March 23.
Three statisticians published a review of the French study that argued that the way it was designed made the treatments look better than they actually are. They pointed to the lack of randomization, as well as an inappropriate control group composed partly of people who refused to take the drug. They also noted that the study dropped some patients from the analysis — the small study of 42 patients actually only included data from 36. The Shanghai study, which showed less impact from the treatments, adds to the questions about the French study, wrote Tim Morris, a statistician at the MRC clinical trials unit at University College, London.
“The [French] study gave very little useful information about whether hydroxychloroquine might help,” Morris wrote. “The Shanghai study is better (because they had a meaningful control group) but gives us very little information that hydroxychloroquine doesn’t help.” The data, he wrote, are “compatible with a wide range of possible effects,” which is statistician-speak for, “Nobody knows whether the drug helps or not.”
The Shanghai study, Morris wrote, is a step in the right direction toward some bigger, better trials that are kicking off. The first of these might give some answers in April — a short time when it comes to clinical trials, but potentially after the United States, and particularly New York City, will have seen a tsunami of Covid-19 cases.
Some doctors on the front lines will use these drug combinations, particularly with patients who are so sick they are on ventilators. As one doctor told me, the risks associated with these drugs, like heart rhythm disturbance or worsening psoriasis, don’t warrant not using them in patients who are in serious trouble. But there is also a need to conduct studies of them to find out if they are truly effective. New York Governor Andrew Cuomo signed an executive order saying that pharmacists should not dispense the drugs to treat Covid-19 unless they are part of a clinical trial. Studies for another drug, remdesivir from Gilead Sciences, are expected to read out in the coming weeks.
Zach Weinberg, one of the co-founders of Flatiron Health, a division of Roche, remembers the difficult transition of going from working in online advertising, where his first company was focused, to Flatiron, which is focused on cancer. In software, more data is better. In cancer, the wrong type of data can lead to conclusions that are not only incorrect but dangerous.
“Sometimes people confuse saying, ‘the study doesn’t tell you anything’ with saying the drug doesn’t work,” Weinberg said. “That’s a really important distinction. They’re not the same thing. I’m not saying the drug doesn’t work or does work. What I’m actually saying is nobody knows if the drug works or doesn’t work.”
His lesson: when dealing with a pandemic, listen to experts who are used to grappling with these problems.
“Society tends to put people who’ve been successful in one area on a pedestal, and draw the conclusion that means they’re expert at many things even though the expertise that they had in one area has nothing to do with the other,” Weinberg said.
About the Author
Matthew Herper
Senior Writer, Medicine
Matthew covers medical innovation — both its promise and its perils.
You go to war with the army you have, not the army you wish you had. Trump is Patton, wanting to attack the enemy now with everything that we have, and Fauci is Montgomery, wanting to wait for the perfect set of circumstances...while people are dying.
The idea of using hydroxychloroquine when patients are deathly ill on respirators is stupid beyond belief: medicines work best at the earliest stages of any disease. Giving someone penicillin for an infection will likely cure them, but not if their leg is already gangrenous. Why would anyone (let alone doctors) think that it is either advisable or a fair test of this medication to dose patients that already have one foot in the grave?
"L'audace, l'audace....Toujours l'audace !"
“I wonder how much big science doesn’t want the generic drug to work...no money in that
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This, plus how many Dems want this crisis to drag on to tank the economy, all the better to defeat Trump? And, YES, I believe that many of them are so devoid of morality and decency that they would kill people to win an election.
Same happen here in South jersey. Atlantic City press had a lead story on a patient who was hospitalized. Within 48 hours of getting the combination he was released to complete his recovery at home.
Bayer, Israel and another company have sent hydroxy to the US.
Company in W. VA has started production.
It is beginning !
It is even better with zinc added to the mix. Hydroxychloroquine works because it lets zinc enter the cells, which effectively stops the replication of the virus (and acts as a preventative if the cell isn’t infected).
I would love to see the results of what I saw on some thread here a few days ago, which is several large doses (1500mg, IV) of Vitamin C given 4x per day. Preliminary results were promising.
If I or a family member get infected, it
I will demand hydroxychloroquine, z-pack, zinc and IV Vitamin C.
Glad he is fine. But in view of his experience,he should mandate its use for all of the patients there.
This chart says that Wuhan flu/covid19 survivors have immunity.
This is big news.
The French Dr. said it would be unfair to create a control group (with placebos) and deny them a slam dunk cure just to prove a point.
That’s how effective HCQ can be. We’ve known it. We’ve seen it in front of our noses for 2 weeks.
Tomorrow Monday is the time to begin mass administration of hydroxychloroquine.
Thanks for those links!!
catnipman wrote:
“
“A few non-clinical trials, doctors using medications on their own, and andanecdotal evidence are not proofs any one cure really works.”
check out these 140 (at the moment) papers published in 2020 regarding treating C-19 with hyroxychorolquine + azithromycin ... how many more studies and papers would you like?
A more important question is: if you or yours fell deathly ill with C-19, would you want those drugs to be tried?
We see quoted large numbers for 'cases'. low numbers for 'recovered, and lowest numbers for death. The large number of missing cases in purgatory should begin to move to recovered tomorrow.
Final worldwide/country and state numbers for the day will be in by 8p EST, 5 pm pacific
I presented it mostly to show that the expected course of the disease from onset to resolution isn't in the order of 2 days, which is what the Chinese study that keeps getting cited by various anti-hydroxychloroquine authors says was the cure time for their control group. The control group for the Shanghai study, and probably also the test group, except for the one outlier at 9 days, were already essentially cured of COVID-19 before the experiment began.
Any study or research out of PRC should be taken at face value and verified. The PRC has lied, failed to inform others in a timely manner, and delayed cooperation regarding COVID-19 during the early period of the disease.
We see quoted large numbers for 'cases'. low numbers for 'recovered, and lowest numbers for death. The large number of missing cases in purgatory should begin to move to recovered tomorrow.
Final worldwide, country and state numbers for the day will be in by 8p EST, 5 pm pacific
We don’t know because it has not been tried at a mass scale.
And then there are those who stand to gain a pretty penny through insider trading.
”Those who are already in the hospitals who are not so critical can be part of the clinical trials. Their survival is not in as much jeopardy. Further, there is another population that can be tested - Those that test positive but are not sick enough to admit to a hospital. A clinical trial of those individuals - i.e. testing of non-critical conditions would allow a better observation of any potential harmful effects.“
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Glad that you see the benefits of use now, but this is the wrong way. Would it be a fair test of the efficacy of penicillin to give it to a guy whose leg was already black from gangrene? No, because ANY medication works best earlier vs. later in the course of a disease. Same for hydroxychloroquine- it works best early, by letting zinc into cells to stop the replication of this disease. If given too late , when their lungs are already full of mucus and they are on a ventilator, it may not do much except postpone death for a few hours or days. This drug, with zinc and a z-pack, should be freely given to ANYONE displaying symptoms who wants it, so long as they are aware of its generally minimal side effects and the fact that a cure cannot be guaranteed (just like any other drug).
Oh, and SCREW the drug companies hoping to get their highly profitable drugs approved in several months, while people die, and SCREW the Trump haters who want to delay an effective treatment so that an extended quarantine tanks the economy.
Amen
Shhh. No one likes the guy who questions a really good circle jerk.
Time is a luxury we do not have.
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