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Hydroxycholoroquine *may* save half the people who were going to die of Covid

Posted By Jo Nova On July 5, 2020 @ 4:07 am In Medicine,Microbiology,Mortality | Comments Disabled

 Good news on the HCQ front

The Henry Ford HCQ study is by no means decisive, but with death rates seemingly halved (sorta, maybe, kinda) — it does show how crazy it is to ban hydroxychloroquine. It also shows it’s low risk, and with all the conflicting studies out there, that there are a lot of ways to stuff things up.

With 10 million cases around the world it seems a bit incongruous that it’s taken so many months to get a trial this basic done with 2,000 patients. When the world only had 10,000 patients in January we already knew that the three drugs that were “fairly effective” were  Remdesivir, Chloroquine and Ritonavir. As far back as February 13, the South Koreans were already recommending hydroxychloroquine and telling us the anti-virals should be “started as soon as possible.” They warned that after ten days, doctors “do not have to start antivirals”. South Korea was the experiment that worked — but we ignored it.

Speaking of slow research, the UK hydroxychloroquine trial that was stopped has restarted again as of three days ago.  This is a trial to see if HCQ can prevent coronavirus in 40,000 healthcare workers.

Perhaps half were saved?

Of those enrolled in the trial, 87% of the people who got hydroxychloroquine (HCQ) survived. This was a lot better than the survival rate of those with neither HCQ nor Azithromycin which was 74%.  Possibly half of those who died in the latter group might have been saved had they got HCQ. But, the study was not  randomized, so we really don’t  know.

Consider that those who got both HCQ and Azithromycin had a lower survival rate (80%) than for HCQ alone. This could be because of some extra risk with azithromycin, some bad interaction with both drugs in combination, or most likely, it was because the doctors gave both drugs to the sickest patients. Indeed, a lot more of the dual treatment patients spent time in the ICU (37%) compared to those in the “neither med” group (15%) and  those treated with HCQ alone (20%). This is the problem with a non-randomized study. We don’t know if the doctors choice of who-to-treat skewed the results. It’s possible the combination of both could have been the best of all.

In comparison, in a randomized trial of the $3,000 remdesivir drug, there was a mortality rate of 8.0%  (treated) versus 11.6% (untreated). Grein et al., 2020. So the HCQ was used on sicker patients with a higher mortality rate, but loosely seemed to have more effect. Given the bargain price of HCQ, long history, mass supplies, and known potential against SARS-1, we wonder why it hasn’t had a proper randomized trial too.

Finally some good coronavirus news for the Trump team. This result will help encourage people to sign up to trials and give doctors back some confidence to use it.

No heart related side effects

One thing it does show is that there were no heart-related side effects, which means it can be low risk and low cost, if done properly. Doctors already know how to screen people who are at risk, which is hardly a surprise given that doctors write 5 million prescriptions for this each year in the US and have done for decades. So let’s get cracking and use it.

Indeed, this shifts the ethical battle — is it fair not to treat patients?

Steroids muddy the resultThe trial involved 2,541 people, but followed them through March and April as doctors treated each person according to their best estimate of what that patient needed. People were given HCQ very quickly once they were hospitalized. But 4 out of 5 were given steroids too, and we know that hydroxycortisone is helpful on its own. Of those on HCQ — twice as many people, 80%,  were also given a steroid compared with 36% in the “neither study drug category”. This is a mess of factors.

Anther factor is that some people were still in hospital and not recovered (and not dead either) and these were just left out. That may end up skewing the results, but presumably the numbers were already large enough, and the clock is ticking… Sigh.

Unless I’m reading it wrongly, the average age of people given some combination of drug was 63, but those given neither were slightly older — 68. The median age of HCQ use alone was 53, while it was 71 for the untreated group. Presumably more of the older patients were at risk of HCQ side effects with long QT intervals. But some of the HCQ benefit might just be due to the age of the patients. The team did “propensity score matching” which presumably matches patients for common risk factors and compares the outcome and then used that to calculate a 51% mortality Hazard reduction rate. Nice.

In our study, overall mortality was 18.1% and in ICU patients 45%. Our cohort included patients with severe disease, with 24% and 18% requiring ICU care and mechanical ventilation at presentation, respectively.

There was no mention of zinc at all in the paper. Perhaps the drug was more effective in people who were not zinc deficient but we’ll have to wait for another study. Could be months.

The bottom line is that HCQ probably is useful, if started early, especially with a steroid.




h/t Skeptical Sam, Orson, Ian B

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