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re: Wow. Brazil Study Shows *early* HCQ significantly decreases hospitalization rates
Posted on 4/17/20 at 4:38 pm to wdhalgren
Posted on 4/17/20 at 4:38 pm to wdhalgren
quote:
It depends. If a trial endpoint is a subjective symptom, for example, pain, then the placebo effect can be quite significant. If the endpoint is hospitalization and the criteria for admission are objective, like hypoxemia, tachypnea, CXR/CT findings, etc., then the placebo effect may be much smaller or non-existent.
I think this is a good point, but I would argue that patients already receiving treatment may be less likely to seek treatment at a hospital than someone who feels like nothing has been done for them yet. With regards to admission, hypoxia/tachypnea may be a criteria for admission, but many people stay happily hypoxic (hypoxia without tachypnea, essentially unaware they are hypoxic) and never require treatment. If you go to the hospital and the doctor sees you are hypoxic (even in the absence of other concerning findings), it's going to be much harder to send that person home. I say this as an ER doc.
1
Posted on 4/17/20 at 4:41 pm to wdhalgren
quote:
I'm not sure what was the point of adding that study to this thread. The study noted in the OP was using HCQ as an early treatment in patients with no current criteria for hospitalization. The study you linked, presumably to make a statement that offset the OP study, was in hospitalized patients. It's quite common for some drugs to work at one stage of a disease but not work as well or at all in a later stage. So, both could be meaningful results and it would still be very good news.
There are many who just don't want it to be effective, and there is no reasoning with them. It is all about Trump all the time
Posted on 4/17/20 at 4:42 pm to wdhalgren
quote:"This needs to be started early to be useful" is a common pro-HCQ argument, and one which I kind of buy into.
I'm not sure what was the point of adding that study to this thread. The study noted in the OP was using HCQ as an early treatment in patients with no current criteria for hospitalization. The study you linked, presumably to make a statement that offset the OP study, was in hospitalized patients. It's quite common for some drugs to work at one stage of a disease but not work as well or at all in a later stage. So, both could be meaningful results and it would still be very good news.
I think their point was that the drug was started early on in those patients as well and that study showed no difference between HCQ vs no treatment. Also it actually looked at patients that had confirmed COVID-19.
Posted on 4/17/20 at 4:46 pm to OKtiger
but medscape news has been blowing up the inconclusive trial about HCQ use in China that was just published.
Posted on 4/17/20 at 4:46 pm to cwil177
quote:
I would argue that patients already receiving treatment may be less likely to seek treatment at a hospital than someone who feels like nothing has been done for them yet. With regards to admission, hypoxia/tachypnea may be a criteria for admission, but many people stay happily hypoxic (hypoxia without tachypnea, essentially unaware they are hypoxic) and never require treatment. If you go to the hospital and the doctor sees you are hypoxic (even in the absence of other concerning findings), it's going to be much harder to send that person home. I say this as an ER doc.
The article detailed how the patients were assessed daily via telemedicine, so I'm assuming it wasn't just a case of treated patients being more oblivious to the fact that they were getting dyspneic and hypoxic. I'm also a physician, retired, and IMO this study is quite suggestive that HCQ has some efficacy in early treatment of Covid. Combine that with the fact that it has a very good and long established safety profile, if I come down with symptoms I'd take it without hesitation until we have something better.
This post was edited on 4/17/20 at 4:51 pm
Posted on 4/17/20 at 4:47 pm to cwil177
I dont know why we think it's some gigantic revelation that hcq wont work 17 days after symptom onset when we know tamiflu doesnt work 48-72h after symptom onset.
different virus I know but we're already used to the concept that sooner = better with viral respiratory infections
different virus I know but we're already used to the concept that sooner = better with viral respiratory infections
Posted on 4/17/20 at 4:48 pm to wdhalgren
I think it's suggestive as well but we don't know if the patients even had COVID.
Posted on 4/17/20 at 4:53 pm to cwil177
quote:
I think their point was that the drug was started early on in those patients as well
Not really. Those patients were started after hospitalization. I don't consider that early treatment.
Posted on 4/17/20 at 4:53 pm to Tiguar
quote:
I dont know why we think it's some gigantic revelation that hcq wont work 17 days after symptom onset when we know tamiflu doesnt work 48-72h after symptom onset.
Tamiflu doesn't work, period
No study (except those by the manufacturer
) have shown any benefit, and that company is currently getting sued by the US government over it. This post was edited on 4/17/20 at 4:56 pm
Posted on 4/17/20 at 4:54 pm to wdhalgren
quote:
Not really. Those patients were started after hospitalization. I don't consider that early treatment.
If you can find me data on COVID+ patients who were treated earlier than that, go ahead and post it here
Posted on 4/17/20 at 4:59 pm to cwil177
quote:
we don't know if the patients even had COVID.
They explained that they didn't wait for test outcomes because of delays in getting those results and their desire to begin treatment ASAP after onset of sx. I haven't read all the fine print in the study; maybe they break down the results of testing that was eventually done. But, assuming that the actual hospitalization outcomes are accurate, and I see no reason to reject them right now, what is the likelihood of some other flu-like illness being prevalent right now in Brazil that is also being effectively treated by HCQ?
The preclinical models of HCQ efficacy vs SARS-CoV have been around for over a decade. Now we have some decent sized outcomes data in a closely related virus. Granted still not robust enough for initial approval of a NCE, but good enough for off label use in a pandemic situation IMO.
This post was edited on 4/17/20 at 5:24 pm
Posted on 4/17/20 at 5:05 pm to cwil177
quote:
If you can find me data on COVID+ patients who were treated earlier than that, go ahead and post it here
I'm not sure what you mean? Did you read the study in the OP? This was a study of early treatment, with the drug given as soon as possible after symptom onset, in patients who fit the clinical profile and did not need to be hospitalized at the time the drug was started. Even if not all of them were tested, they showed a treatment benefit as a group.
Medications are given on an empiric basis all the time, and this group did so in order to begin treatment expeditiously. The fact that it made a highly significant difference in outcomes is useful data.
This post was edited on 4/17/20 at 5:25 pm
Posted on 4/17/20 at 5:05 pm to SloaneRanger
quote:
Of course you must disbelieve this - if Trump says it "shows promise" it must be bad.
quote:
Rather people die than have Trump proven correct.
quote:
Libs furiously downvoting anything that might be positive
quote:
Of course, Democrats would have screamed because there would not be a crisis now.
quote:
CNN and dem governors say it doesn’t do anything and is in fact killing people because they are eating fish cleaner because Blonald Flumpf told them to!!!
REEEEEEEEEEEEE!!!!
quote:
There are many who just don't want it to be effective, and there is no reasoning with them. It is all about Trump all the time
wait, who is making this about Trump?
This post was edited on 4/17/20 at 5:07 pm
Posted on 4/17/20 at 5:32 pm to cwil177
quote:
wait, who is making this about Trump?
Every fricking leftist--that;s who. They are on their knees praying it doesn't work-simply because Trump said it MIGHT.
Posted on 4/17/20 at 5:35 pm to wdhalgren
quote:
I'm not sure what you mean? Did you read the study in the OP?
Yeah, and the patients weren't tested for COVID. Which is why I made that statement.
quote:
The preclinical models of HCQ efficacy vs SARS-CoV have been around for over a decade. Now we have some decent sized outcomes data. Granted still not robust enough for initial approval of a NCE, but good enough for off label use in a pandemic situation IMO.
I think this is a solid enough argument, but again, was the HCQ in OP's study treating COVID or not? This study doesn't tell us. HCQ has antiviral activity against several viruses, including flaviviruses, HIV, Zika, retroviruses, coronaviruses, hepatitis C, HPV, influenza, orthomyxoviruses, as well as general activity against viral replication factors.
This study provides no evidence that HCQ is effective against COVID specifically, but maybe it helps all-comers with viral illness, hence the effect purported by this study. If you can make any conclusion from this study it's that maybe we should just give HCQ to anyone with the sniffles.
Posted on 4/17/20 at 5:46 pm to OKtiger
This has not been peer-reviewed or submitted to a reputable journal. Approach with caution, but the results seem good.
Posted on 4/17/20 at 6:00 pm to cwil177
quote:
If you can make any conclusion from this study it's that maybe we should just give HCQ to anyone with the sniffles.
Or maybe we should give it to anyone with Pandemic like sx while the pandemic is ongoing? Obviously we're not going to agree here. You seem hard line on the requirement for rigorous efficacy testing no matter the situation.
Personally, I think it's reasonable to use HCQ right now, particularly early after sx onset in high risk patients, maybe randomize it in low risk patients. The drug is available in large quantities, cheap, safe with nearly a century of heavy use, known to work in viral models (including a closely related coronavirus), and showing signs of clinical efficacy. The volume of new cases every day and the relatively brief disease course would make it quick and easy to gather robust outcomes data, while possibly lowering the level of m&m in a short time frame.
This post was edited on 4/17/20 at 6:05 pm
Posted on 4/17/20 at 6:03 pm to wdhalgren
(no message)
This post was edited on 7/1/20 at 1:51 am
Posted on 4/17/20 at 6:06 pm to dandyjohn
quote:
dandyjohn
quote:
yep, brazil and india is where i want to get my cutting edge healthcare from.
India is where a staggering amount of your pharma meds are made. They're huge in the medical industry. Turns out that when they switched to a capitalist, open/free-market economy back in 1994, they've had staggering amounts of economic growth in the intervening quarter century.
But don't let me get in the way of your narrative about India.
Posted on 4/17/20 at 6:12 pm to cwil177
quote:
"This needs to be started early to be useful" is a common pro-HCQ argument, and one which I kind of buy into.
The study itself is finally the first of its kind to look specifically at early use. Every other study has been looking at the drug's efficacy when the patient is hospitalized (ie. 16-17 days after infection)
This is not a drug that is a miracle cure. It seems to be useful in the early stages of disease. Again, the philosophical differences we have is whether it is ethical or not to give a placebo to a patient that could very well develop complications because no treatment was given. No patient is going to willingly sign up for the chance to be given a sugar pill when the drug in question was voted as the most effective treatment available according to a poll of over 6,000 doctors worldwide.
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