According to NPR the National Institutes of Health is raining on the HCQ parade:
A panel of experts convened by the National Institute of Allergy and Infectious Diseases recommends against doctors using a combination of hydroxychloroquine and azithromycin for the treatment of COVID-19 patients because of potential toxicities.
“The combination of hydroxychloroquine and azithromycin was associated with QTc prolongation in patients with COVID-19,” the panel said.
QTc prolongation increases the risk of sudden cardiac death.
The recommendation against their combined use would seem to fly in the face of comments made by President Trump suggesting the combination might be helpful. On March 21, for example, the president described them in a tweet as having a “real chance to be one of the biggest game changers in the history of medicine.”
There are also some other treatments they recommend against:
But occasionally, there are recommendations explicitly against certain therapies. For example, the panel recommended against using Lopinavir/ritonavir or other HIV protease inhibitors because of negative clinical trial data. It also recommended against using interferon because it seemed to make patients with SARS and MERS worse. Those diseases are caused by a coronavirus related to the one causing COVID-19.
“It’s all based on the data,” said panel member Dr. Susan Swindells, a professor in the department of internal medicine at the University of Nebraska College of Medine. “We just plowed through everything that was, and apart from supportive care, there wasn’t anything that was working terribly well.”
The panel also concluded that there was insufficient evidence to recommend any kind of treatment either to prevent infection with the coronavirus or to prevent the progression of symptoms in those who are already infectious. That recommendation could change based on clinical trials presently underway.
I don’t have any ox to get gored in this discussion but I wonder how the NIH explains the experience in South Korea? Or are they just discounting it completely?
Just to pass along a little gossip I heard according to one doc I’ve spoken with South Korea’s strategy for handling their COVID-19 outbreak made it impossible for other countries to follow its lead, at least in the near term which was when it would have been necessary. The country had already sucked up all of the necessary supplies. Just gossip, as I say.
Maybe l’m being attacked by an extra dose of cynicism today, but if the rumor contained content about how trump screwed up, it would be held up, as “factual,†and find it’s way to a news network, or be a front page story in some MSM publication. That seems to be the way today’s information Highway travels and tilts
So many experts, with alllllll that expertise…………………….and so little to show for it. But of course its all data driven, except……… well, take it up with Neil Ferguson.
It is sort of funny.
There is actually no gold standard proof (double blind, randomized clinical trial) for anything anyone has tried for coronavirus.
Not just HCQ, Ramdesvir, BCG vaccine, lopinavir, Vitamin C, D, proning, ventilators, etc… but including measures such as masks, lockdowns, out of home quarantines, test/track/trace.
On a meta level, we don’t have gold standard proof that waiting for the results of a randomized trial will lead to better outcomes then trying things now and doing observational studies. We need a double blind, randomized clinical trial to prove waiting for clinical trial results is the best approach.
Here is what the report actually says.
“There are insufficient clinical data to recommend either for or against using chloroquine or hydroxychloroquine for the treatment of COVID-19 (AIII).
When chloroquine or hydroxychloroquine is used, clinicians should monitor the patient for adverse effects (AEs), especially prolonged QTc interval (AIII).”
“The COVID-19 Treatment Guidelines Panel (the Panel) recommends against the use of hydroxychloroquine plus azithromycin for the treatment of COVID-19, except in the context of a clinical trial (AIII).”
There are no recommendations for or against any drug for prophylaxis. The above are for hospitalized patients. Oddly enough, there are no mentions of Trump. The reason NPR addresses it is that Trump put himself into the conversation without knowing if the drug works or if it is safe for those who have Covid.
What was not data driven about it? They cite a number of individual studies and foot note others. I assume you read those and disagree? (Just kidding, I know you are just being an A hole.)
” so little to show for it.”
Yes. The A hole in chief told us it is a great drug and it works so now it is controversial because ehe brought it up. In fact, as soon as the French guy published this everyone jumped on it. His talking about it didnt help at all. It may have harmed people. We wont know until the studies are finished. In the middle of a crisis we need leaders to be responsible. Trump was not. If there is anything for which he should be censured, this was it. The problem we face is that everyone wanted to go start their own study. We have lots of studies with 40, 60 or 80 patients. Not powered enough to be very useful.
“There is actually no gold standard proof (double blind, randomized clinical trial)”
There arent many of those for a lot of stuff we do. Decent observational studies are often the best we get.
Query- Why is that you are convinced that HCQ works and you dont need any kind of study or proof, just Trump’s word, but dont want to believe that masks, lockdowns etc work?
Steve
Dear Steve,
It’s not Trump’s word. There are several studies that support HCQ’s use against COVID-19. They are not, however, rigorous double-blind experiments using randomized treated subjects and placebos. But if the crisis is as urgent as the NIH/CDC/FDA claim, then there is no reason not to try HCQ and other “unproven†treatments. Especially since the medical establishment has crashed the world’s economy, giving us Great Depression II.
Yours,
Bob
That includes “stay at home” directives and wearing facemasks.
Bob- Did you read those studies? They were small, too small to have meaningful results. They dropped out data that would mitigate against the positive result. In one of those studies the average age of the patients was about 40 and it was mostly women in the group. If I wanted to bias a study about a drug for Covid in favor of using the drug I would pick a lot of younger women.
NONETHELESS, we went ahead and tried using HCQ plus AZ. We were desperate and contra what your right wing media tells you we really dont have to have a double blind study for everything. The largest study of which I am aware is the VA study. It found that a lot more died if they took HCQ. With that result you know what was recommended? Keep using HCQ if you want. One study is not enough to prove it is harmful yet. What has been recommended is that we not give HCQ with AZ as people are seeing (we saw it at our hospital) more arrhythmias.
You know what sucks? We couldn’t just evaluate this drug like any other drug. Now, unless the literature shows that HCQ works you guys arent going to accept it. Trump cannot fail, Trump can only be failed.
Steve
“A hole in chief???†Wow, beneath-the-belt digs don’t dignify a person.
POTUS’s roll in calling attention to HCQ, has paralleled his reasoning behind the “The Right To try Act,†in giving people a larger array of survival options, in making available drugs yet to have gone through the rigorous but lengthy FDA approval process. Not waiting for studies anointing HCQ with clinical approval irks some people like Steve. However, for those who thought they were going to die from this virus, only to improve once given this combination of drugs, they don’t care if scientific protocols came second to their ability to access it.
Fundamentally, I find it unfortunate that mindsets, riveted to proven, authoritative medical agendas, seem so aggrieved when people step out of these protocols, responding compassionately with something that may only be a “possibility,†instead of waiting for a sick person to be ventilated and then die.
Steve: All the studies I’ve read state that HCQ+ is relatively ineffective in very ill hospitalized patients but much more so in mildly ill patients. I think Dr. Zelenko is a grandstander. But South Korea seemed to have had some success, and there seems to be a lot of anecdotal supposed ‘cures’ out there from people who don’t seem to have an ax to grind or a personal horn to toot. Also I haven’t seen recent illness/death tolls for Kung Flu out of India, much of whose populace has been on HCQ for years if not decades. I have to trust your own personal opinion from your experiences, but I have problems dismissing all the anecdotes as BS. We still know too little about the disease, how it kills, etc. etc. The reason why China banned internal flights within China from Wuhan but permitted them to continue overseas completely mystifies me. I hope the answer to that and other questions doesn’t turn as ugly as some conspiracy mongers claim it to be (I’m still supporting accidental release followed by face-saving coverup to save local asses).
Tars- I hope I have made it clear that all of the cited studies refer to inpatient care. There isnt anything out on prophylaxis to keep people out of the hospital so we can hope it helps there. Even with inpatient use we arent getting rid of the drug. People can still use it. The evidence against it not working is far from rock solid and once we have good studies we may find out is good for certain pts and not others.
Steve
Now Nicotine?
https://www.dailymail.co.uk/health/article-8246939/French-researchers-plan-nicotine-patches-coronavirus-patients-frontline-workers.html
In other news they have revealed that some Frenchmen don’t smoke. I don’t believe I’ve ever met any.
I’m skeptical of this. For one thing it’s contradicted a bit by the difference in incidence of the disease between men and women. The difference in prevalence of smoking by gender is the opposite. If it were true (at least based on my experience) it would have been impossible for the disease to begin community spread in either China or India.
Steve: I was thinking more of your own experience but I’m glad to have the in-patient/out-patient confusion cleared up. I have also seen where many studies seem to have tested HCQ only and in some cases excessive doses of HCQ. Anything in excess doses can hurt.
A link to a site hosting a Belgian paper positing that correcting for zinc deficiency may improve outcomes:
https://www.preprints.org/manuscript/202004.0094/v1
I keep on pestering you with these links because any life saved by a new treatment is a life saved.
Anecdotal evidence is fine as long as we remember that’s exactly what it is. I’ve also read some suggest the link between hypertension and bad covid-19 outcomes is related to Ace Inhibitors somehow opening the door to the lungs and heart for the virus. Remember your grain of salt. I think all this flailing around for answers is necessary due to our lack of knowledge. Maybe one of these will hold a key. Maybe not.
B.P. meds:
https://www.reuters.com/article/us-health-conoravirus-blood-pressure-ins/blood-pressure-drugs-are-in-the-crosshairs-of-covid-19-research-idUSKCN2251GQ