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  #51  
Old 05-08-2020, 01:17 PM
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Originally Posted by Ann Hedonia View Post
But the researchers acknowledged that the treated group was, in general, way sicker than the untreated group. And they performed an elaborate set of adjustments based on the age, condition, medication history and insurance of the patients. These adjustments the reduced degree of negative outcome.
They are using propensity scores, similar to the VA study which also found hydorxycholroquine was not a useful treatment. This is a standard method of doing experiments when a randomized trial is not possible, and can give reliable results when done well.
  #52  
Old 05-22-2020, 10:56 AM
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New reporting is out on a large study of the benefits of the Hydroxychloroquine based treatment regimens. The authors compared data from approximately 15,000 treated patients with data from untreated hospitalized patients. The various protocols seem to be associated with an increased mortality of between 34% and 45%, and an increased risk of heart arrhythmias ranging from 137% and 411% depending on the protocol.

https://www.washingtonpost.com/healt...navirus-study/

https://www.thelancet.com/journals/l...180-6/fulltext

“In this large multi-national real world analysis, we did not observe any benefit of hydroxychloroquine or chloroquine (when used alone or with a macrolide) on in-hospital outcomes, when initiated early after a diagnosis of COVID-19. Each of the drug regimens of chloroquine of hydroxychloroquine alone or in combination with a macrolide was associated with an increased hazard fir a clinically significant occurrence of ventricular arrhythmias and increased risk of in-hospital death with COVID-19.”

Willful ignorance is toxic

TL:dr Hydroxychloroquine- More Death, No Benefits

Last edited by Ann Hedonia; 05-22-2020 at 11:00 AM.
  #53  
Old 05-22-2020, 12:31 PM
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Originally Posted by Ann Hedonia View Post
...

Willful ignorance is toxic

TL:dr Hydroxychloroquine- More Death, No Benefits
Thank you for this. Not surprising in the least either.
  #54  
Old 05-22-2020, 12:39 PM
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Of course, it's simple, they're not giving the patients enough zinc!


CMC fnord!
  #55  
Old 05-22-2020, 12:42 PM
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That's awful. I can't blame them for trying something but it actually reduced their survival chances rather than helping them.

Last edited by Dark Sponge; 05-22-2020 at 12:44 PM.
  #56  
Old 05-22-2020, 01:53 PM
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That's awful. I can't blame them for trying something but it actually reduced their survival chances rather than helping them.
The awful thing is that so many tried it, when there were other treatments which they could have tried and which were more likely to succeed. The popularity of this one crowded out other options, and gave humanity less useful data to operate on.

Last edited by Sage Rat; 05-22-2020 at 01:54 PM.
  #57  
Old 05-22-2020, 02:04 PM
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TL:dr Hydroxychloroquine- More Death, No Benefits
No. TL: DR is it probably isn't something you give very ill people since by that time its probably already too late to help them.But might be useful early on.

Politics aside, hydroxychloroquine could (maybe) help fight COVID-19

On the Lancet study

Quote:
Isn’t there already evidence that hydroxychloroquine doesn’t work against COVID-19?
Yes, and no. Very few rigorous trials of the drug have reported data. Some people were given the drug in studies in which there wasn’t a control group that got placebos, and results from some of those studies have been mixed, with some reporting benefits, others showing no effect, and some indicating that the drugs may even be harmful for some patients. Even the latest data from the large multinational study in the Lancet combined studies that used the drugs in different doses and in different ways that may not be directly comparable.
Quote:
But just because the drug didn’t seem to help in late stages of the disease, that doesn’t mean it won’t be effective if given early, perhaps even before people are exposed to the virus, Avidan says.

“If you bring on a star player consistently [only] in the last minute of a game and you’re still losing, you might say, ‘This star player is no good,’” Avidan says. “But that’s not a good use of your star player, because most of the outcome is already established at that very late stage.” Bringing a star in early to play the whole game, he says, may produce a much better outcome.
And almost as if speaking directly to Ann Hedonia

Quote:
Because of reports of harm in very sick COVID-19 patients, “people have kind of forgotten about the decades of safety data that we do have in an ambulatory, healthy population,” she says.

Last edited by AK84; 05-22-2020 at 02:04 PM.
  #58  
Old 05-22-2020, 02:32 PM
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Moreover the fact that this drug has become a target of political polarisation is disastrous. Trumps support and enthusiasm is misplaced. But the opposite reactions, like those of Ann Hedonia is just as bad, treating it as if its akin to leeching or giving prayers and incense.

Like this. Emphasis supplied.
Politics Around Hydroxychloroquine Hamper Science
Quote:
But for some researchers, running such trials is becoming more difficult because of the controversy around the drug.

Missed opportunity

Dr. Jon Giles didn't expect to have any problems drumming up interest in his clinical trial testing if hydroxychloroquine can help prevent COVID-19.

"We were getting calls all the time from people who were interested," says Giles, an epidemiologist and rheumatologist at Columbia University.

For his study, Giles planned to give a short course of the medication to people who were "household contacts" of COVID-19 patients. Like many of the ongoing trials, it would be randomized with a control group.

By the end of April, Giles was ready to start enrolling people. But his team ran into a problem when they started calling potential participants.

"Pretty much everybody said, 'Well that's the drug that's dangerous to your heart,' or, 'I talked to my friends and they said don't take it,' or that 'I saw on TV it's dangerous,' " says Giles.

Just a month earlier, he says demand for the drug was soaring. Some patients with autoimmune conditions couldn't even get their prescriptions filled, after Trump spoke enthusiastically about the drug.

In April, the FDA issued a warning about using the drug for COVID-19 patients without strict medical supervision in a hospital or as part of a clinical trial. The agency had received reports of serious heart-related adverse events and death in patients with COVID-19 receiving hydroxychloroquine and chloroquine.

But the back-and-forth headlines and the ongoing political wrangling seemed to make people wary of the medication, Giles says, even in the context of a carefully run clinical trial.

"It became almost impossible to get anyone interested," says Giles.

Giles says the committee overseeing his study added a new requirement: that study participants needed to have had an electrocardiogram within the last year.

As a rheumatologist, Giles knows the medication better than most doctors because he prescribes it to many of his patients.

"It's a very, very safe drug; it's been used for over 75 years," he says. "When I give someone hydroxychloroquine, I don't get an ECG or do blood monitoring."

Giles was planning to enroll otherwise healthy people and screen out anyone who could be at risk of heart problems. But that new requirement, plus the negative press, made it too difficult to find study subjects.

He gave up on doing the study. He says it's a missed opportunity.

"It's not unreasonable to think that a short course of this drug might have some protective ability," he say
s.

Risks and potential

The concern over cardiac risk for hospitalized patients is real, says Dr. Mark Poznansky, director of the Vaccine and Immunotherapy Center in the Infectious Disease Division of Massachusetts General Hospital. Even though the drug has been used safely to prevent malaria, he says, "that is very different from using the drug in acutely ill patients with COVID-19."

He recently published a review of the evidence for using hydroxychloroquine to treat COVID-19 that casts doubt on its effectiveness.

"The data up to date ... doesn't make one entirely optimistic that we are going to find something different in a clinical trial," he says.

Poznansky notes a recent study of nearly 1,400 people with moderate to severe COVID-19 found no benefit and concluded that the drug should not be routinely used on patients.

He says the drug should only be used in the context of clinical trials "or under strict compassionate use, in order to do no harm."

Still, Poznansky doesn't rule out that further well-designed trials could turn up better results.

'The virus doesn't care about politics'

At Henry Ford Health System in Detroit, cardiologist Dr. William O'Neill says enrollment for their clinical trial studying hydroxychloroquine to prevent COVID-19 plummeted in late April.

"It really caused a huge problem for us," O'Neill says. "It set us back probably a month."

O'Neill attributes the drop in enrollment to the FDA warning and a highly publicized study of over 300 hospitalized veterans with COVID-19. The authors of that study found the drug did not reduce the need for a ventilator and even linked hydroxychloroquine to higher death rates. However, the study wasn't a rigorous controlled trial and the results weren't peer-reviewed.

"That was interpreted as a warning that the drug is dangerous," says O'Neill. But he says, using it for prevention is a different matter than treating already sick patients. "Everything that we see about hydroxychloroquine suggests that the earlier you use the drug, the more likely it is to be effective."

O'Neill says the fact that President Trump is touting this drug means it now has become a political flashpoint.

"It has made people absolutely committed to proving him wrong," he says.
  #59  
Old 05-22-2020, 02:42 PM
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Yay sound bites vs. studies. Very convincing wall of words.
  #60  
Old 05-22-2020, 02:59 PM
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I’m going to be posting something longer, but I want to make a comment with regards to the comment about the safety data so I doesn’t get lost inside a longer post.

The proven safety profile is for the dosages used for rheumatic illnesses. Unfortunately, and this seems to be the catch, the anti-viral effects don’t kick in at that concentration, they require a much higher dosage. The recommended dosages for COVID patients were considerably higher than that for rheumatic diseases.
  #61  
Old 05-22-2020, 03:11 PM
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Yay sound bites vs. studies. Very convincing wall of words.
There are plenty of studies supporting HCQ use as well.
The "sound bites (sic)" that you state are a "convincing wall of text" are actual scientist who are explaining why its not a silver bullet and probably not useless either.Including those who have carried out studies or are using it the drug clinically.



https://www.drugs.com/dosage/hydroxy...se_for_Malaria

Quote:
Originally Posted by Ann Hedonia
The proven safety profile is for the dosages used for rheumatic illnesses. Unfortunately, and this seems to be the catch, the anti-viral effects don’t kick in at that concentration, they require a much higher dosage. The recommended dosages for COVID patients were considerably higher than that for rheumatic diseases.
While the exact dosage is not yet clear, what you say is wrong.

HCQ is recommended for Lupus, Arthritis, Malaria and Malaria prophylaxis.

The dose for COVID19 is
Quote:
800 mg salt (620 mg base) orally on day 1, followed by 400 mg salt (310 mg base) orally once a day
Total duration of therapy: 4 to 7 days, based on clinical evaluation
WHich is not much higher than that for malaria.
Quote:
800 mg salt (620 mg base) orally as an initial dose, followed by 400 mg salt (310 mg base) at 6, 24, and 48 hours after the initial dose
Total dose: 2000 mg salt (1550 mg base)
  #62  
Old 05-22-2020, 04:59 PM
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I know I’ve been really vocal on the subject. My opinions on the subject have nothing to do with my politics or my feelings towards President Trump.

It’s been an interest of mine since 2004, when my boyfriend was diagnosed with Stage 4 pancreatic cancer. The doctor gave him a 5% chance of living one year, we took at as a challenge. We stopped working with the first couple of doctors that recommended standard treatment while getting our affairs in order. We found out there were a lot of treatments out there and we became convinced that all we had to do was find the right one.

We saw an article in the Wall Street Journal about a new and innovative test. The reason chemo wasn’t curative was that most people didn’t pick the right one. All we had to do was test the various chemotherapies against a tumor sample. We managed to find the doctor that developed the test and got him to take us as a patient.

It didn’t work, he died and over the next several months my head cleared and I was able to see through the bullshit. At the time I was active in several online cancer groups. I saw people make the same mistakes we did and I began helping people realistically analyze experimental and innovative medical treatments.

When the world first began raving about Hydroxychloroquine, I was skeptical.
I did a little basic research. I found a long history of the drug being studied as an anti-viral without much success. I found no theory that explained why this drug that was ineffective against flu and other SARS viruses might work against COVID. I realized there would be a basic issues with dosages.

I was not impressed at all with the early unreviewed studies that showed promise, because I had seen so many similar documents regarding dubious cancer treatments. Some of these unreviewed papers remind me of sovereign citizen lawsuits, they are sometimes convincing because they look so real.

Viruses are, in general, a particularly intractable pharmaceutical issue. At any given moment, there are hundreds of researchers looking for compounds that are effective against viruses inside the human body. It’s a tough problem and the successes have been minor. In that atmosphere difficult to believe that there’s a quick and easy cure unless you buy into the idea that “this is something that THEY don’t want you to know about”, and that slides into conspiracy theory territory.

Lastly, it’s always tricky studying treatments for illnesses that most people recover from naturally. You’re always going to get lots of anecdotes about the guy that took the drug and got better in the next day or so and you can’t give them too much weight.

I don’t think it’s like leeches or prayer. But I do think it’s kicking around in that large gray area that sits between science and pseudoscience, you know - that place where Dr. Oz lives.

That molecule may even provide a starting point for a drug that works, maybe they can make a synthetic with a stronger anti-viral effect and less toxicity. But I find the fact that it was so heavily promoted and distributed with virtually no evidence horrifying. And I know that no matter how many negative studies come in, their will be people that will always believe. They gave too much or too little or too early or too late.

I’m not going to go into the politics of the drug here, except to say that the right wing advocacy of the drug is deep and disturbing and the only reason we even know the drug exists.
  #63  
Old 05-22-2020, 05:16 PM
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While the exact dosage is not yet clear, what you say is wrong.

HCQ is recommended for Lupus, Arthritis, Malaria and Malaria prophylaxis.

The dose for COVID19 is

WHich is not much higher than that for malaria.
Other sources give somewhat higher dosages. For example, this study reports

Quote:
In an exposure driven post-exposure prophylaxis setting, 800 mg loading dose followed in 6 hours by 600 mg, then 600 mg daily for 4 more days achieved daily troughs above EC50 in >50% subjects. These doses are higher than recommended for malaria chemoprophylaxis, and clinical trials are needed to establish safety and efficacy.
That dose is 3800mg, or nearly twice what is recommended for malaria prophylaxis.
  #64  
Old 05-22-2020, 05:40 PM
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I had been looking at the actual dosages used in the various trials - some which exceeded the doses in the EUA, which erred on the side of safety. Both links in post 61 go to the information for malaria prophylaxis, which is based on WEEKLY dosing, not daily dosing.

But dosing is a problem when it comes to effectiveness, and the various studies have been attempting to split the baby. This source talks about the effective serum concentration, or how much of the drug needs to get into the bloodstream in order to be effective. And that number is way higher -4.5x to 17x - than the effective serum concentration for lupus and similar diseases.

https://www.physiciansweekly.com/cov...xychloroquine/

And it’s worth noting that a study of patients taking the drug for lupus and other disorders got COVID at pretty much the same rate and severity as a similar group not on the medication.
  #65  
Old 05-22-2020, 11:25 PM
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The FDA emergency approval for Remdesivir "allows the drug to be given to patients with COVID-19 only if they are severely ill ...
That's odd,
since my understanding is that remdesivir is like tamiflu, it's supposed to work best if you take it after exposure but before you get sick, and becomes less and less useful the further the disease progresses.
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Originally Posted by Ann Hedonia View Post
...
I don’t think it’s like leeches or prayer...
Hey, my dad literally cured a guy via blood-letting. Leeches would have worked fine, although needles were used. My dad diagnosed the man as having hemochromatosis.

But I agree with your broader point. I'm just being picky.
  #66  
Old 05-23-2020, 09:06 AM
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Hey, my dad literally cured a guy via blood-letting. Leeches would have worked fine, although needles were used. My dad diagnosed the man as having hemochromatosis.

But I agree with your broader point. I'm just being picky.
If we are going to be picky, one does “cure” hemochromatosis (at least not the hereditary kind).
  #67  
Old 05-23-2020, 01:12 PM
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Fair enough. He cured the man's symptoms, but yes, the guy had to have his blood drawn regularly to stay healthy. The guy had been sick for a while, though, and was so grateful to finally be healthy that he invited my father and his little children onto his fishing boat in Boston harbor for a day. I have never been so bored in my life! Although I did eat the best flounder I've ever had that evening, with the added relish of having caught it myself.
  #68  
Old 05-29-2020, 02:55 PM
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And now serious questions raised about the Lancet study.
https://www.nytimes.com/2020/05/29/h...ne-lancet.html
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