Study released today showing effectiveness of hydroxychloroquine/azithromycin combo for COVID-19?

The Quarantine Zone
1

It sure would be awesome if a combination of two old, cheap, generic drugs were a magic bullet, but will it be? I am getting mixed feedback from friends in health professions.

One (an advanced practice nurse) forwarded me a journal article that was released today - unfortunately I haven’t found the article itself online yet - and said some of her friends have already started using the protocol when warranted. The other (a pharmacist) says the journal results aren’t really that great, but it’s full of medical jargon that I need to read again tomorrow with a clear head. Here’s what the article’s authors say (in French - my crappy translation to follow):

Marseille, March 22, 2020

Covid-19 coronavirus outbreak

In the current context of the spread of the Covid-19 coronavirus epidemic on French territory and worldwide. In accordance with the Hippocratic Oath that we have taken, we obey our duty as doctors. We provide our patients with the best care for the diagnosis and treatment of a disease. We respect the rules of the art and the most recently acquired data of medical science.

We have decided:

· For all febrile patients who come to consult us, to carry out tests to diagnose Covid 19 infection;

  • For all infected patients who have lung lesions on CT scan, many of whom are not very symptomatic, to propose as soon as possible, as soon as the diagnosis is made:

  • a treatment with a combination of hydroxychloroquine (200 mg x 3 per day for 10 days) + Azithromycin (500 mg on the 1st day then 250 mg per day for 5 more days), as part of the precautions for use of this association (including an electrocardiogram on D0 and D2), and outside of marketing authorization [off-label use? my medical French is not so fabulous. If yours is better, please elaborate]. In cases of severe pneumonia, a broad-spectrum antibiotic is also used.

We believe that it is unethical not to systematically include this combination in therapeutic trials for the treatment of Covid-19 infection in France.

Pr Philippe Brouqui, Pr Jean-Christophe Lagier, Pr Matthieu Million, Pr Philippe Parola, Pr Didier Raoult, Dr Marie Hocquart

Meanwhile, the pharmacist friend is already getting people bringing in questionable prescriptions for this therapy written by doctors in unrelated specialties, and is really pissed off, because of course that means the drugs are already backordered and not available to people who need them for COVID-19 or any other reason.

Any medical professionals care to comment on the validity of the study? Any French speakers want to correct my translation? Has anyone seen the actual study published online anywhere? (I have a .pdf copy.) Does anyone care to comment on the medical ethics of trying an off-label use in a situation like this?

In what situations is it warranted to try an unproven treatment?

(The draft of the article that I have is Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID-19, International Journal of Microbial Agents. I think it’s a draft because it still has a bunch of typos and minor grammatical errors.)

2

Numerous mentions of these anti-malarial drugs, in the context of Covid-19 usage and also that I’ve seen previously, commonly mention the horrific side-effects of these drugs, without ever going into detail. Even our own resident doctor, Qadgop the Mercotan, mentioned it in one of these threads recently.

These are apparently some industrial-strength drugs with some industrial-strength side effects.

From what I’ve been able to find about these drugs, these side effects can include “neurological compromise”, better known as “brain damage” that could in some cases be non-trivial and possibly long-lasting.

These are not drugs I would want to be messing around with.

Can any doctor on this Board give more information about this?

3

They’re using this drug combination in Spain.

I’ve been following this ER doctor that’s been documenting his personal experience with Coronavirus. He posts symptoms & ultrasound of his lungs daily.

He’s been taking azithromycin+HCQ. Day 15 and No dyspnea or red flag symptoms.

It’s not a fast cure. Dr Chen is still experiencing symptoms and some issues with his lungs.

https://mobile.twitter.com/yaletung?ref_url=https%3A%2F%2Fwww.nbcnews.com%2Fhealth%2Fhealth-news%2Flive-blog%2Fcoronavirus-updates-live-u-s-cases-top-1-000-spread-n1155241%2Fncrd1155371

4

Here’s the earlier post I referred to:

ETA: IIRC I did see it mentioned somewhere that hydrochloroquine is a little bit lighter on the side effects that chloroquine, for what that’s worth.

5

And I don’t know that anyone is proposing treating millions with it just yet, even the study’s authors. But we are in a situation where there may not be a lot of good options, and I don’t see that improving anytime soon. If I were in critical condition with COVID-19-induced pneumonia and there were no respirators or ICU beds, I might be willing to take my chances.

6

What the typical length of the coronavirus infection, anyway? I could sell you a lot of things that will cure the flu in 10-14 days and they would all work. That’s one reason why clinical trials with controls are so important.

I would be nice to be hopeful, but this kind of very preliminary evidence very frequently doesn’t pan out. Especially when the evidence for a mechanism of action is not that strong, neither medicine was developed to target viruses - they seem to be medicines for unrelated conditions that happen to also have some mild anti-viral effects.

I saw these elevated hopes a lot back when I was active in cancer support groups and I saw so many allegedly promising therapies turn out to be absolutely worthless ( and never saw anything pan out) that I am always skeptical.

And even if a treatment works, it’s not going to be some miracle cure. It may make the symptoms less intense or shorten the duration- which could greatly reduce fatalities. And they also have to be sure that their endpoints are valid in the real world.

I believe the measurement of effectiveness in the one limited trial I read about was viral load as determined by a nasal swab. I could see that it was reduced greatly, but how does that transfer to clinical results? Were any symptoms reduced? Were the patients less sick? Did they get well faster than untreated patients? That is what really matters.

One bright spot is that even a minor reduction in symptoms could make a large difference in reducing fatalities.

7

Unfortunately there are many available test subjects for a clinical trial. Selecting a large sample of people won’t be difficult.

They need to set up trials ASAP. Like this week. Find out if this drug combination works. Does it ease symptoms? Help avoid pneumonia?

It’s already being tried in Europe. The US is behind and must catch-up on the latest treatments for Covid-19.

8

All over the world they are trying this combination. But getting results will take time. Until then, it is not ethical to start treating the general population of patients with something that might not work as expected and definitely has the potential for beyond horrific side effects.

We have to hunker down and wait until some avenue of research gives fruit. There are lots of teams all over the world trying lots of things to find a treatment (and this is without taking into account the teams that are working on vaccines). And I am confident that, in time, some team will find something worthwhile. But until there is definite evidence that something works (and until that something is made widely available), the only thing we can do is to keep at home as much as we can, and do our best to avoid infection.

9

IANAD, but I’ll bet that everyone in need of hospital care for Covid-19 is being treated with SOME antibiotic to prevent pneumonia. Someone may have run numbers, and noticed that people treated with azithromycin, as opposed to some other antibiotic, recovered faster.

But who knows? I am allergic to penicillin, so I am given azithromycin for bacterial infections (except when I am given Cipro for some specific things-- mostly bladder/UTI). Anyway, while it’s not true in my case, people allergic to penicillin often have other allergies, and may jump to going to the doctor for health problems sooner than other people, because they are harder to treat. So there could be a subset of people given azithromycin who have multiple allergies, and sought medical care when they were in earlier stages of the disease. So, maybe getting palliative care early helps you recover faster.

I’m not proposing that as fact. I’m just describing it because I want to illustrate that A doesn’t always mean B. You have to watch the “post hoc, ergo propter hoc” mistakes.

However, if early palliative care, or something, results in faster recovery, we need to figure out what that something is. If petitions to the flying spaghetti monster speed recovery, we need to establish that.

Exactly. If some group we can define is recovering faster, we need to hustle trying to figure out why.

10

Dr Oz has interviewed the French doctor.

Oz has setup a randomized trial through Columbia University. Hopefully it will yield useful data.

https://mobile.twitter.com/droz

https://www.google.com/url?sa=t&source=web&rct=j&url=https://video.foxnews.com/v/6144015101001&ved=2ahUKEwixiILr4bDoAhVKG80KHS_AB68QFjALegQIAhAB&usg=AOvVaw207OhRU_mELk120xtNODyx&cshid=1584972303395

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You know Doctor Oz is a quack, right?

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Unfortunately, he’s not a quack. He just acts like one a lot, which is even more frustrating.

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Doctor Oz may be a quack on some subjects, but he is also a cardiac surgeon and medical school professor at Columbia University.

14

Oz is a cardiothoracic surgeon affiliated with Columbia University.

I agree he has supported some odd alternative medicine on his show.

The trial he setup at Columbia will be just one of several.

I understand it takes conclusive data for a treatment to be used in the US.

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No, I don’t think so. Many drugs are used for ‘off label’ purposes.

16

Dr Oz is reportedly a very good surgeon.

That has little to do with being able to properly run a research study, which requires a different skillset.

It’s possible that he is also a brilliant medical researcher, but his skill as a surgeon and his visibility in pop culture do not indicate either way whether this is true. His peddling of snake oil remedies is a strike against him in that regard.

It is only his celebrity that makes this notable at all, not his academic achievements. If Columbia is running such a study, I would hope they are just using him for his name, let others do the real work, and designate a wrangler to keep him out of their hair.

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https://www.nature.com/articles/s41421-020-0156-0

Linked above is a paper in Nature - hydroxychloroquine shown effective against covid-19 in vitro.

18

Should be only hydroxychloroquine above

19

Is hydroxychloroquine similar to quinine? Maybe we should all take up drinking gin & tonics again

20

NY starts Clinical trials Tuesday.