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The Latest Hydroxychloroquine Data, As of April 11:
We have new data on hydroxychloroquine therapy to discuss. The numbers will not clear anything up.
The good news is that the HCQ/sulfasalazine comparison does not show any real differences in adverse events over one-month courses of treatment. I should note that sulfasalazine is not the most side-effect-free medication in the whole pharmacopeia, but it has not been associated with (for example) QT prolongation, which is one of the things you worry about with hydroxychloroquine. The paper concludes that short-term HCQ monotherapy does appear to be safe, but notes that long-term HCQ dosing is indeed tied to increased cardiovascular mortality.
The trouble comes in with the azithromycin combination. Like many antibiotics (although not amoxicillin), AZM is in fact tied to QT prolongation in some patients, so what happens when it's given along with HCQ, which has the same problem?
Worryingly, significant risks are identified for combination users of HCQ+AZM even in the short-term as proposed for COVID19 management, with a 15-20% increased risk of angina/chest pain and heart failure, and a two-fold risk of cardiovascular mortality in the first month of treatment.
That isn't good. I am very glad to hear that the Raoult group has observed no cardiac events in their studies so far, but I wonder how they have managed to be so fortunate, given these numbers.
Update: here is another new preprint from a multinational team lead out of Brazil. It enrolled 81 patients in a trial of high-dose hydroxychloroquine (600 mg b.i.d. over ten days, total dose 12g) or low-dose (450mg b.i.d. on the first day, qd thereafter for the next four, total dose 2.7g). All patients also received azithromycin and ceftriaxone (a cephalosporin antibiotic). The high-dose patients showed more severe QT prolongation and there a trend toward higher lethality compared to the low dose. The overall fatality rate across both arms of the study was 13.5% (so far), which they say overlaps with the historical fatality rate of patients not receiving hydroxychloroquine. The authors actually had to stop recruiting patients for the high-dose arm of the study due to the cardiovascular events, but they're continuing to enroll people in the low-dose group to look at overall mortality. The paper mentions that HCQ has been mandated as the standard therapy in Brazil, so there is no way to run a non-HCQ control group, though.
(Score: 2, Interesting) by Anonymous Coward on Monday April 13 2020, @01:31AM (5 children)
The climate change denying French doctor? God help us all.
(Score: 5, Interesting) by driverless on Monday April 13 2020, @02:34AM (4 children)
Thanks for that bit of info. Did a bit of checking on him, he sounds like rather a nutcase, doesn't believe in control groups or randomisation in clinical trials and a bunch of other stuff. It's perfectly OK to be a maverick/eccentric if you're an artist, but not when lives are at stake.
(Score: 2, Insightful) by Anonymous Coward on Monday April 13 2020, @03:40AM (3 children)
Many of the most amazing medical discoveries from the years come would never have come from sober and cautious thought.
Penicillin is the most obvious example. It was discovered entirely by accident. A scientist inadvertently left a petri dish of bacteria. A bluish green mold had formed among it, likely due to a nearby open window. However, there was inhibited bacterial growth around the mold. The scientist isolated the mould, cultured pure samples and validated his discovery. It actually took years for it to be accepted by the medical profession at large because of how absurd it sounds. If you don't get the implication here - the way you treat bacterial infections, what antibiotics originally were derived from, is that nasty blue-green mold that emerges on rot. Sounds like an awesome thing to inject into somebody with an infection!
Chemotherapy is another. We have German chemical weapons and World War 1 to thank here. It was observed in the victims of mustard gas that it dramatically inhibited cell division and replication. It wasn't long after that that they were injecting humans with what was essentially a chemical weapon, and reaping immense rewards for it.
And many more throughout the decades and centuries. Vaccines were discovered in a similar fashion. It was observed that the milk maids who caught cow pox seemed to never get smallpox. So let's intentionally give people cowpox! Turns out it was a really good idea. Interestingly from the discovery and confirmation of the study it would end up taking around 50 more years for the worldwide medical profession to accept it. Again, just sounds kind of crazy literally giving people cowpox.
Modern medicine more geared towards producing profitable drugs than anything that can actually help people. It's macabre but there's no doubt that part of the reason that there was little enthusiasm for e.g. vitamin C (massive dosing of which has also shown positive effects against corona) or hydroxychloroquine is because they're not profitable. Hydroxychloroquine is a 50 year old drug, and vitamin C is effectively free. Ideally making money and making drugs that actually help people would be the same thing, but they're not. See things such as the hyper-rapid growth in psychotropic medication use in the US which on the macro level is not only *not* showing results, but seems to be having an adverse effect given the crazy high rise of mental illness in the US. People are popping pills, going crazy, and pharmaceutical companies are getting rich off it.
(Score: 3, Insightful) by Anonymous Coward on Monday April 13 2020, @07:03AM
All of those results included testing with control groups. You're missing the point?
(Score: 4, Insightful) by DeathMonkey on Monday April 13 2020, @03:01PM (1 child)
Discovery happens by accident all the time.
Verifying that your discovery is actually real is where the science comes in.
Verifying your real discovery doesn't have murderous side effects is where the medical testing comes in.
Completing all three is when you get to start selling it to end users.
(Score: 2) by driverless on Tuesday April 14 2020, @05:07AM
And specifically for hydroxychloroquine, the Brazilian trial had a 13.5% fatality rate, which makes it more deadly than Covid19. This is exactly why we have clinical trials.