Chloroquine trials - Printable Version
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RE: Chloroquine trials - Mick - 03-25-2020
(03-25-2020, 02:15 PM)stupac2 Wrote: There's a reason you do studies on these things.
Sometimes people just get better. There's a reason why, before modern scientific medicine, people believed all kinds of crazy things helped them (and why people still do, despite all evidence to the contrary).
https://www.youtube.com/watch?v=xzYO0joolR0
RE: Chloroquine trials - oldalum - 03-25-2020
(03-25-2020, 02:11 PM)martyup Wrote: Why would anyone resist trying something that may save lives?Only way to know if it is useful is to use it in a clinical trial. While the clinical trial is ongoing, in this situation where there is no known effective treatment, it can be used on a "compassionate use" basis outside of the trial as long as the drug is not in scarcity and the trial can enroll the desired number of patients.
RE: Chloroquine trials - akiddoc - 03-25-2020
(03-25-2020, 02:11 PM)martyup Wrote: Why would anyone resist trying something that may save lives? Under a Dr's supervision this medication has little downside re side effects. Dr. Fauci recommends prescribing it to severe cases. I trust him more than some tweet saying "nada."
Oh, and now we are trusting "controlled" studies from China?
There are perfectly good medical studies that come out of China. Why wouldn't there be? There are also lousy studies. Lousy studies from here as well.
RE: Chloroquine trials - TreesAndBirds - 03-26-2020
Recent study from China. Not showing efficacy but very small and maybe losing something in translation.
Abstract re. Hydroxychloroquine.
浙江大学学报（医学版） 2020 年 3 月
JOURNAL OF ZHEJIANG UNIVERSITY March 2020
SONG Shuli, ZHANG Dandan, QIAN Zhiping, LI Tao, SHEN Yinzhong, LU Hongzhou
(Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan
University, Shanghai 201508, China)
Corresponding author: LU Hongzhou, E-mail: luhongzhou@fudan.edu.cn, https://orcid.org/0000-0002-
8308-5534
[Abstract] Objective: To evaluate the efficacy and safety of hydroxychloroquine (HCQ) in the
treatment of patients with common coronavirus disease-19 (COVID-19). Methods:
We prospectively enrolled 30 treatment-naïve patients with confirmed COVID-19 after informed
consent at Shanghai Public Health Clinical Center. The patients were randomized 1:1 to HCQ
group and the control group. Patients in HCQ group were given HCQ 400 mg per day for 5 days
plus conventional treatments, while those in the control group were given conventional treatment
only. The primary endpoint was negative conversion rate of COVID-19 nucleic acid in respiratory
pharyngeal swab on days 7 after randomization. This study has been approved by the ethics
committee of Shanghai public health clinical center and registered online (NCT04261517). Results: One
patient in HCQ group developed to severe during the treatment. On day 7, COVID-19 nucleic acid of
throat swabs was negative in 13 (86.7%) cases in the HCQ group and
14 (93.3%) cases in the control group (P＞0.05). The median duration from hospitalization to
virus nucleic acid negative conservation was 4 (1-9) days in HCQ group, which is comparable to
that in the control group [2 (1-4) days, (U = 83.5, P ＞ 0.05)]. The median time for body
temperature normalization in HCQ group was 1 (0-2) after hospitalization, which was also
comparable to that in the control group 1 (0-3). Radiological progression was shown on CT
images in 5 cases (33.3%) of the HCQ group and 7 cases (46.7%) of the control group, and all
patients showed improvement in follow-up examination. Four cases (26.7%) of the HCQ group
and 3 cases (20%) of the control group had transient diarrhea and abnormal liver function (P＞
0.05). Conclusions: The prognosis of common COVID-19 patients is good. Larger sample size
study are needed to investigate the effects of HCQ in the treatment of COVID-19. Subsequent
research should determine better endpoint and fully consider the feasibility of experiments such as
sample size. [Key words] Severe acute respiratory syndrome coronavirus 2; Corona virus disease-19;
Novel
coronavirus pneumonia; Hydroxychloroquine; Treatment outcome; Safety
2019 年 12 月，湖北省武汉市陆续出现多例不明原因肺炎，并迅速蔓延
[1]。2020 年 1 月
31 日，WHO 将这次疫情列为国际关注的突发公共卫生事件
[2]。基因序列分析结果显示，本次
疫情的病原体为β属冠状病毒，与严重急性呼吸综合征（severe acute respiratory
syndrome, SARS）病毒高度同源，国际病毒分类委员会将其命名为严重急性呼吸综合征冠
RE: Chloroquine trials - BostonCard - 03-27-2020
Nice discussion of what the trial does and does not tell us.
https://www.fiercepharma.com/pharma-asia/did-chloroquine-really-fail-a-covid-19-study-or-was-it-just-trial-design-s-fault
BC
RE: Chloroquine trials - oldalum - 03-27-2020
A study from France purporting to show that "hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin" is pretty worthless. (I believe this is the study Trump referred to.) It was not randomized (control and treatment groups were not comparable; the 20 controls were obtained from a different hospital and those who refused to participate in the study), and 6 cases out of 26 cases from the treatment group were lost to follow-up: 3 were transferred to the ICU (none in the control group were), 1 died (none in the control group died), 1 left the hospital, and 1 stopped treatment due to nausea. At least 4 of those should probably be regarded as "treatment failures" but were not included in the analysis. published study
RE: Chloroquine trials - BostonCard - 03-29-2020
Good interview with a virologist about the possible use of chloroquine/hydroxychloroquine, including the theory behind why it could work and the possible drawbacks.
https://advances.massgeneral.org/research-and-innovation/article.aspx?id=1145&utm_medium=email&utm_source=marketo-providers&utm_campaign=FY20-pulmonaryadvances-28mar2020-coronavirus
BC
RE: Chloroquine trials - CompSci87 - 03-29-2020
(03-29-2020, 04:53 PM)BostonCard Wrote: Good interview with a virologist about the possible use of chloroquine/hydroxychloroquine, including the theory behind why it could work and the possible drawbacks.
https://advances.massgeneral.org/research-and-innovation/article.aspx?id=1145&utm_medium=email&utm_source=marketo-providers&utm_campaign=FY20-pulmonaryadvances-28mar2020-coronavirus
BC
Thanks for that. Interesting info!
RE: Chloroquine trials - BostonCard - 03-31-2020
https://www.mediterranee-infection.com/wp-content/uploads/2020/03/COVID-IHU-2-1.pdf?mod=article_inline
Observational trial reports clinical improvement, except in the patients that didn't improve. What I wouldn't give for a randomized, placebo controlled trial with a hard outcome. It will come...
BC
RE: Chloroquine trials - BostonCard - 04-02-2020
Yeah! A randomized, placebo controlled trial:
https://www.nytimes.com/2020/04/01/health/hydroxychloroquine-coronavirus-malaria.html
Here's the study (not yet peer reviewed):
https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v2
Quote:Aims: Studies have indicated that chloroquine (CQ) shows antagonism against COVID-19 in vitro. However, evidence regarding its effects in patients is limited. This study aims to evaluate the efficacy of hydroxychloroquine (HCQ) in the treatment of patients with COVID-19. Main methods: From February 4 to February 28, 2020, 62 patients suffering from COVID-19 were diagnosed and admitted to Renmin Hospital of Wuhan University. All participants were randomized in a parallel-group trial, 31 patients were assigned to receive an additional 5-day HCQ (400 mg/d) treatment, Time to clinical recovery (TTCR), clinical characteristics, and radiological results were assessed at baseline and 5 days after treatment to evaluate the effect of HCQ. Key findings: For the 62 COVID-19 patients, 46.8% (29 of 62) were male and 53.2% (33 of 62) were female, the mean age was 44.7 (15.3) years. No difference in the age and sex distribution between the control group and the HCQ group. But for TTCR, the body temperature recovery time and the cough remission time were significantly shortened in the HCQ treatment group. Besides, a larger proportion of patients with improved pneumonia in the HCQ treatment group (80.6%, 25 of 32) compared with the control group (54.8%, 17 of 32). Notably, all 4 patients progressed to severe illness that occurred in the control group. However, there were 2 patients with mild adverse reactions in the HCQ treatment group. Significance: Among patients with COVID-19, the use of HCQ could significantly shorten TTCR and promote the absorption of pneumonia.
(emphasis, mine)
If you look at the full paper, it appears that they shortened the duration of fever and cough by a day (3.2 to 2.2 days for fever and 3.1 to 2.0 for cough). Small study (n = 62), but it was at least an RCT.
BC
RE: Chloroquine trials - stupac2 - 04-02-2020
I'd be curious of there's any statistical power there with such a small n. I know you can have it if the effect size is large enough. It seems like more than 4/62 patients should normally progress to severe symptoms, but how much more depends on definitions.
RE: Chloroquine trials - martyup - 04-02-2020
Great news. I'm sure glad that the feds green lighted the treatment early. It has probably already saved many lives. Now I would love to see the results of a trial using HCQ for health care workers to lessen their chances of contracting the virus.
RE: Chloroquine trials - 2006alum - 04-02-2020
For what it's worth:
[tweet]https://twitter.com/First10EM/status/1245744547528916992?s=20[/tweet]
RE: Chloroquine trials - OutsiderFan - 04-02-2020
The top medical minds and scientists in the world would have coalesced around the drug being a legit difference maker if it really is. Every one I have heard or read talk about it have been quite skeptical.
RE: Chloroquine trials - martyup - 04-02-2020
(04-02-2020, 07:28 PM)OutsiderFan Wrote: The top medical minds and scientists in the world would have coalesced around the drug being a legit difference maker if it really is. Every one I have heard or read talk about it have been quite skeptical.
The top medical minds in the world are recommending it and have said that they would take it if they got sick.
RE: Chloroquine trials - dabigv13 - 04-02-2020
The data is limited. It may help some patients. It certainly is not by any chance a cure.
RE: Chloroquine trials - BostonCard - 04-02-2020
In God we trust; all others must bring data.
--W. Edwards Deming
That seems to be the EMA'S position:
https://www.fiercepharma.com/pharma/europe-locks-down-chloroquine-scripts-as-researchers-china-report-positive-controlled-covid
Quote:In guidance Wednesday, the European Medicines Agency restricted general use of the drugs—already approved to treat malaria and autoimmune diseases—to patients taking them for approved indications. COVID-19 patients can receive the drugs as part of clinical trials or through national emergency use programs, the EMA said.
BC
RE: Chloroquine trials - Goose - 04-02-2020
(04-02-2020, 09:21 PM)BostonCard Wrote: In God we trust; all others must bring data.Amen. Things are also not always black and white. It may help to some degree in some cases and not in others. It is pretty clear at this point it is not a panacea. The data will say if it is useful. I must admit I find it annoying that peoples opinion, even experts opinion, is weighted so heavily in the absence of data. At one point bleeding was the standard of care. Even though almost all the "experts" endorsed it, there was no data to back up the idea. I would hope we are beyond that today, but frankly I am not sure we are.
--W. Edwards Deming
RE: Chloroquine trials - OutsiderFan - 04-03-2020
It's been pretty well-established that humans have a tendency to be more optimistic about things they want to happen than the reality really warrants.
Cocaine was once considered a miracle drug:
https://www.pbs.org/newshour/show/cocaine-how-miracle-drug-nearly-destroyed-sigmund-freud-william-halsted
RE: Chloroquine trials - burger - 04-03-2020
(04-03-2020, 04:59 AM)OutsiderFan Wrote: It's been pretty well-established that humans have a tendency to be more optimistic about things they want to happen than the reality really warrants.Especially when optimism aligns with people's political opinions.
Cocaine was once considered a miracle drug:
https://www.pbs.org/newshour/show/cocaine-how-miracle-drug-nearly-destroyed-sigmund-freud-william-halsted