Chloroquine trials - Printable Version

Chloroquine trials - Printable Version

+- The CardBoard (https://thecardboard.org/board)
+-- Forum: Emergency (https://thecardboard.org/board/forum-11.html)
+--- Forum: Covid-19 (https://thecardboard.org/board/forum-12.html)
+--- Thread: Chloroquine trials (/thread-19212.html)

Pages: 1 2 3 4 5 6 7 8 9

RE: Chloroquine trials - BostonCard - 05-07-2020

Yes, they are the 95% confidence intervals. Here's the table of numeric results:

[Image: nejmoa2012410_t2.jpeg]

You can see the effect of confounding by indication; unadjusted hydroxychloroquine patients were over twice as likely to require mechanical ventilation or die. However, using a few methods of adjustment (multivariable analysis, propensity adjustment via inverse probability weighting, matching, and adjustment for propensity scoring) basically gives you the same answer. There is always the possibility of some residual confounding, but again, it is clear that it is not a game changer.

BC

RE: Chloroquine trials - BostonCard - 05-07-2020

Not sure how I missed this article:

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2765361?guestAccessKey=c87ca05c-350e-4a00-87d9-a92876ee21f3&utm_source=silverchair&utm_campaign=jama_network&utm_content=covid_weekly_highlights&utm_medium=email

Quote:Demand for chloroquine and hydroxychloroquine increased substantially following endorsements by high-profile figures and remained high even after a death attributable to chloroquine-containing products was reported. In times of public health crises, therapies not supported by adequate evidence—such as would lead to US Food and Drug Administration approval—should not be touted by public figures. Endorsements can lead to unsupervised use of the products with dangerous consequences to the people who take them, and hoarding of these medications can result in shortages for those who require them for legitimate health reasons. These negative consequences are magnified in this circumstance because chloroquine-containing products are commercially available to the public through such sites as Amazon.

In case you are wondering, they only looked at searches connected to a purchase like "buy chloroquine" or amazon searches for hydroxychloroquine, etc.

BC

RE: Chloroquine trials - Mick - 05-07-2020

(05-07-2020, 03:21 PM)BostonCard Wrote: I really wish he would stick to his core competency of reality show hosting, rather than snake oil salesmanship.

BC

I think snake oil salesmanship is his core competency.

RE: Chloroquine trials - BostonCard - 05-13-2020

Another negative observational trial of hydroxychloroquine and COVID-19.

https://jamanetwork.com/journals/jama/fullarticle/2766117?&utm_source=BulletinHealthCare&utm_medium=email&utm_term=051320&utm_content=NON-MEMBER&utm_campaign=article_alert-morning_rounds_daily&utm_uid=2938679&utm_effort=MRNRD0

Like the other observational study, this one is hampered by the fact that the patients who received HCQ were sicker, and there is only so much you can do with adjustment. Again, though, if it were a "game changer" we probably would have seen something.

This will only be settled once the results of the large randomized, placebo-controlled studies come out. However, at this point, I would be a little surprised if they showed a benefit (though there are plenty of cases where observational studies and randomized, placebo-controlled studies, yielded different results).

BC

RE: Chloroquine trials - magnus - 05-18-2020

Apparently, the President has been taking it for a couple weeks now in a preventative sort of way.

https://www.cnn.com/2020/05/18/politics/donald-trump-hydroxychloroquine-coronavirus/index.html

Quote: Asked if the White House doctor recommended he begin taking hydroxychloroquine, Trump demurred.

"I asked him what do you think, he said, 'Well if you'd like it,' " the President told reporters.

I have to wonder what kind of dosage Trump is taking. Given the side effects including heart related issues (that apparently he may be susceptible to?), it doesn't seem like a good idea for a doctor to just let him take this drug.

RE: Chloroquine trials - dabigv13 - 05-18-2020

I'm sure he's just lying again.

RE: Chloroquine trials - burger - 05-18-2020

(05-18-2020, 02:59 PM)magnus Wrote: Apparently, the President has been taking it for a couple weeks now in a preventative sort of way.

https://www.cnn.com/2020/05/18/politics/donald-trump-hydroxychloroquine-coronavirus/index.html

Quote: Asked if the White House doctor recommended he begin taking hydroxychloroquine, Trump demurred.

"I asked him what do you think, he said, 'Well if you'd like it,' " the President told reporters.

I have to wonder what kind of dosage Trump is taking. Given the side effects including heart related issues (that apparently he may be susceptible to?), it doesn't seem like a good idea for a doctor to just let him take this drug.

I'll bet dollars to donuts that either A) he's lying completely, or B) he thinks he's taking it, but his doctors (who do not want to lose their licenses) are giving him Flintstones vitamins or some other placebo.

RE: Chloroquine trials - JustAnotherFan - 05-18-2020

Now that folks are going to start going hard with the Hydroxycure nonsense again, can anyone tell me if there has been any study that has actually supported taking it either to (1) ward off a potential virus, or (2) treat it?

RE: Chloroquine trials - OutsiderFan - 05-18-2020

Thank you, burger for the laugh! Flinstones vitamins - LOL!

In all seriousness, the 25th Amendment is needed. The Republican Party will never live down supporting such an epic disaster of a POTUS. The damage done to our most revered institutions is unforgivable, to say nothing of the body count and fiscal disaster in his wake.

The Walt Harris at Stanford of Presidents, but I don’t recall anyone clamoring for him to be retained.

RE: Chloroquine trials - dabigv13 - 05-18-2020

(05-18-2020, 05:40 PM)OutsiderFan Wrote: Thank you, burger for the laugh! Flinstones vitamins - LOL!

In all seriousness, the 25th Amendment is needed. The Republican Party will never live down supporting such an epic disaster of a POTUS. The damage done to our most revered institutions is unforgivable, to say nothing of the body count and fiscal disaster in his wake.

The Walt Harris at Stanford of Presidents, but I don’t recall anyone clamoring for him to be retained.

One of my first memories is eating a whole canister of Flintstones vitamins, and then having to get my stomach pumped because of it (they used to have enough iron in them to be dangerous at high doses apparently, but they were delicious tasting so what kid wouldn't want to chow down).

JAF, there were early studies with small numbers of patients that suggested perhaps some benefit. The larger, later, better designed studies have not shown any benefit. I'm not aware of any studies that have been done to evaluate prophylaxis.

RE: Chloroquine trials - JustAnotherFan - 05-19-2020

(05-18-2020, 05:49 PM)dabigv13 Wrote:
(05-18-2020, 05:40 PM)OutsiderFan Wrote: Thank you, burger for the laugh! Flinstones vitamins - LOL!

In all seriousness, the 25th Amendment is needed. The Republican Party will never live down supporting such an epic disaster of a POTUS. The damage done to our most revered institutions is unforgivable, to say nothing of the body count and fiscal disaster in his wake.

The Walt Harris at Stanford of Presidents, but I don’t recall anyone clamoring for him to be retained.

One of my first memories is eating a whole canister of Flintstones vitamins, and then having to get my stomach pumped because of it (they used to have enough iron in them to be dangerous at high doses apparently, but they were delicious tasting so what kid wouldn't want to chow down).

JAF, there were early studies with small numbers of patients that suggested perhaps some benefit. The larger, later, better designed studies have not shown any benefit. I'm not aware of any studies that have been done to evaluate prophylaxis.

Thanks, dabigv13. Looks like they're running at least one such trial: https://www.fox13news.com/news/tampa-general-hospital-workers-in-clinical-trial-using-hydroxychloroquine-as-covid-19-preventative.amp

RE: Chloroquine trials - Mick - 05-19-2020

(05-18-2020, 05:40 PM)OutsiderFan Wrote: In all seriousness, the 25th Amendment is needed. The Republican Party will never live down supporting such an epic disaster of a POTUS. The damage done to our most revered institutions is unforgivable, to say nothing of the body count and fiscal disaster in his wake.

The Walt Harris at Stanford of Presidents, but I don’t recall anyone clamoring for him to be retained.

Interestingly, the 25th amendment would be more effective applied to Biden than Trump. The 25th amendment is used for incapacitated Presidents, not those with whom we strongly disagree and/or despise. Even if the requisite politicians mounted the appropriate coup, all Trump would have to do is state that he's capable of executing the duties of the President of the United States. He's not senile...yet. Whereas, given his rate of deterioration, I could see Biden not being able to muster up that simple sentence. I firmly believe Biden will be elected, and I've been saying so for a very long time. But basically, you're voting for whoever he selects as VP, because that's who'll be running the country within a year after the inauguration.

On another topic, here's a poll of 2,000 adults, conducted three weeks ago. To quote the last paragraph: "Meanwhile, 30% of those polled think President Trump was unprepared at the beginning of the pandemic, but 62% think that he has handled the crisis well overall." Yikes.

https://www.studyfinds.org/three-in-four-americans-agree-universal-healthcare-is-needed-during-coronavirus-pandemic/

RE: Chloroquine trials - BostonCard - 05-20-2020

https://detroit.cbslocal.com/2020/05/20/how-can-i-be-sick-woman-who-took-hydroxychloroquine-for-19-years-to-treat-lupus-still-got-covid-19/

Quote:“When they gave the diagnosis, I felt like it was a death sentence. I was like, ‘I’m going to die,'” she said. “I’m like, ‘How can I be sick? How? I’m on the hydroxychloroquine.’ They were like, ‘Well, nobody’s ever said that was the cure or that was going to keep you safe’ and it definitely did not.”

Repeat after me... not a gamechanger.

BC

RE: Chloroquine trials - oregontim - 05-20-2020

(05-18-2020, 05:40 PM)OutsiderFan Wrote: Thank you, burger for the laugh! Flinstones vitamins - LOL!

In all seriousness, the 25th Amendment is needed. The Republican Party will never live down supporting such an epic disaster of a POTUS. The damage done to our most revered institutions is unforgivable, to say nothing of the body count and fiscal disaster in his wake.

RE: Chloroquine trials - oregontim - 05-20-2020

(05-19-2020, 09:25 PM)Mick Wrote: The 25th amendment is used for incapacitated Presidents, not those with whom we strongly disagree and/or despise.

I think the president's behavior in public — the repetitions, the seriously shrinking vocabulary, the instant attacks, the obsessions with crowd sizes, Obama, political enemies, self congratulation — are evidence of serious decline of cognitive skills. Is that man mentally fit to be trusted with executive leadership of a nation? Commander in chief of the world's largest military?

You really don't think he's senile?

Quote:On another topic, here's a poll of 2,000 adults, conducted three weeks ago. To quote the last paragraph: "Meanwhile, 30% of those polled think President Trump was unprepared at the beginning of the pandemic, but 62% think that he has handled the crisis well overall." Yikes.

https://www.studyfinds.org/three-in-four-americans-agree-universal-healthcare-is-needed-during-coronavirus-pandemic/

Well said. Yikes indeed.

RE: Chloroquine trials - BostonCard - 05-20-2020

Let's keep this thread focused on chloroquine, and not the fitness for office of Trump or Biden.

BC

RE: Chloroquine trials - JustAnotherFan - 05-22-2020

Front page of CNN right now:

Drug touted by Trump as Covid-19 treatment linked to a greater risk of death, study finds

https://www.cnn.com/2020/05/22/health/us-coronavirus-friday/index.html

RE: Chloroquine trials - M T - 05-22-2020

(05-22-2020, 08:24 AM)JustAnotherFan Wrote: Front page of CNN right now:
Drug touted by Trump as Covid-19 treatment linked to a greater risk of death, study finds
https://www.cnn.com/2020/05/22/health/us-coronavirus-friday/index.html

Here's the actual study report.

It is pretty clear to me that the patients that were in worse shape were given the medicines (and thus wound up in this study's test groups).

One could use this study's "control group" to see what factors give better outcomes.
Indeed, based on this study, I wonder if being a former smoker is actually beneficial for COVID-19.

Let's see, what are the factors associated with worse outcomes (and reported by this study):
Older: Control group was younger than any of the test groups.
Male: Control group had fewer males than any of the test groups.
Overweight: Control group had lower BMI than any of the test groups.
Race: Control group had more whites than 3 of the 4 test groups
Comorbidities:
Coronary artery disease: Control group was less afflicted than any of the test groups.
Congestive heart failure: Control group was less afflicted than any of the test groups.
Arrhythmia: Control group was in the middle of the groups.
Diabetes: Control group was less afflicted than any of the test groups.
Hypertension: Control group was much less afflicted than any of the test groups.
Hyperlipidaemia: Control group was more afflicted than 3 of the 4 test groups.
COPD: Control group was less afflicted than 3 of the 4 test groups.
Current smoker: Control group was less afflicted than any of the test groups.
Former smoker: Control group was more afflicted than any of the test groups.
Immunocompromised: Control group was in the middle of the groups.
Disease Severity
qSOFA: Control group was less afflicted than any of the test groups.
SPO2: Control group was less afflicted than any of the test groups.

Maybe, they somehow overcame the statistical one-sidedness of their data by adjusting for it, but then I have to wonder if the conclusions are just a reflection of how over or under that adjustment was.

I do see how a particular media outlet that dumps on Trump would tout the higher deaths in the test group, but I don't think that's good science. But it promotes the message that outlet wants to promote. As for me, I'd file this study in the trash bin.

[This study aside (as it should be), I think the President is not behaving wisely in taking this drug.]

RE: Chloroquine trials - BostonCard - 05-22-2020

(05-22-2020, 01:04 PM)M T Wrote: Maybe, they somehow overcame the statistical one-sidedness of their data by adjusting for it, but then I have to wonder if the conclusions are just a reflection of how over or under that adjustment was.

Indeed they did:

Quote:To minimise the effect of confounding factors, a propensity score matching analysis was done individually for each of the four treatment groups compared with a control group that received no form of that therapy. For each treatment group, a separate matched control was identified using exact and propensity-score matched criteria with a calliper of 0·001. This method was used to provide a close approximation of demographics, comorbidities, disease severity, and baseline medications between patients. The propensity score was based on the following variables: age, BMI, gender, race or ethnicity, comorbidities, use of ACE inhibitors, use of statins, use of angiotensin receptor blockers, treatment with other antivirals, qSOFA score of less than 1, and SPO2 of less than 94% on room air. The patients were well matched, with standardised mean difference estimates of less than 10% for all matched parameters.

Basically what they did is for each patient in the treated arms, they found a patient in the control arm that "matched" them based on the criteria (more specifically, their propensity score, which is the probability that they would be treated based on their baseline characteristics). The question you pose is a good one, and basically amounts to a term called residual confounding, the idea that the adjustment might be inadequate and that some other factor(s) might be there that they failed to adjust for. The authors note this as a limitation in their study.

Quote:Due to the observational study design, we cannot exclude the possibility of unmeasured confounding factors, although we have reassuringly noted consistency between the primary analysis and the propensity score matched analyses.

I think at this point we are at the limits of what observational data can tell us. They bring up some red flags as they have consistently shown no benefit and possible harm, but there is no getting around the methodological limitations. So, we will await the results of the randomized, placebo controlled studies (for example, the WHO has one) before making a firm conclusion, but at this point, I wouldn't give a patient of mine CQ/HCQ outside of a clinical study.

BC

RE: Chloroquine trials - M T - 05-22-2020

Given two alternatives for a baseball player, of the same gender, height, weight, race, smoking, gambling, etc, I'd bet the one the manager puts in as the designated batter is more likely to get a hit than the one that the manager didn't include on the team.

The doctors weren't choosing which patients to put on the medication randomly. Trying to go back and balance things out seems to presume that the doctors were just look at the equivalent of the back of a baseball card to decide who should get what treatment. I believe in doctors much more than that.

I did go back to the report and found the per-drug-combination controls in the appendix. Not perfect alignments, but much better and close enough. I withdraw my concern about the control group being distorted based on the listed parameters.

Then I looked at outcomes. (I don't know what the "Outcome" line is under "Outcomes". Is that Mechanical Ventilation or Mortality? Why is that line blank on some treatments?)

Those in the test groups (ie, taking some of the drugs) seem to have WAY worse outcomes (roughly 1.5x ICU days, 2x number on ventilators, 1.5x to 2x mortality).

I understand why arrythmia is much worse (increasing from under 0.5% to 6-8%) as anticipated. But would a doctor believe these drugs somehow resulted in a requirement for more mechanical ventilation? Is that likely to be an effect of the drug, or an effect of the doctors putting the sicker patients on the drugs?

If the study's authors really believe in their methodology, why is their finding a wimpy "associated with decreased in-hospital survival" rather than a stronger statement?

[To clarify, my questions are not being put to any one to offer an answer. They are expressions of lack of understanding of why the authors wrote what they did.]