Chloroquine and Hydroxychloroquine as treatments for Covid-19

It happens that in a past life I had an allergic reaction to chloroquine, after I took it for a bout of malaria. I was living in a village in PNG where malaria was endemic, so was on weekly prophylaxis, but still came down with malaria. The treatment was yet more chloroquine, which did end the bout. But then I took my usual weekly dose, which tipped me into the reaction: I broke out in hives all over, for which I took a strong antihistamine, but I also had hallucinations for a night or two. NOT an experience I ever wished to repeat!
The villagers were amused to see the red splotches on my light skin, and told me cheerfully that malaria medicine makes you itch, and recommended I sit in the river to make it feel better!
The hives took a while to go away completely, and extreme itching even longer. And the villagers were right — sitting with my feet in a bucket of water temporarily soothed the itchiness.
Dismayed that chloroquine is being promoted without adequate research, certainly I’d only take it again under careful medical supervision.

 

Adequate research has yet to be done, but my best guess is this drug, alone or in combination, is more likely to be used on severe infections, where the relative risk will be different from mild cases. The biggest issue though is what happens to survival rates, and what percentage get serious complications. That is why further research is required.

 

https://twitter.com/user/status/1242889208651448322

 

Further to this.

https://forbetterscience.com/2020/0...r-raoult-to-save-the-world-from-covid-19/amp/

 

By the way, just want to add that hydroxychloroquine is a significantly less toxic drug than chloroquine, and so would seem to be a better treatment prospect, assuming comparable efficacy.

 

There is a bit of push back on hydroxychloroquine hype early in the recent TWiV podcast. Basically they are saying the study was not correctly controlled because patients decided if they wanted experimental treatment or not based on how they were feeling and HCQ needs to be properly trialled as the cohorts were very small, the treated cohort had more mortality than the untreated controls and so it does not provide conclusive evidence HCQ is helpful in a clinical setting.

http://www.microbe.tv/twiv/twiv-593/

 

https://www.theguardian.com/world/2...ink-hydroxychloroquine?CMP=Share_iOSApp_Other

 

Attached is a newly released randomized, blinded, placebo-controlled study of hydroxychloroquine in mildly sick, hospitalized Covid patients in China. Sample size is fairly small at 62.

One inclusion criteria was that oxygen saturation at baseline had to be above 93%. According to a physician interviewed on Vincent Racaniello's podcast last week, oxygen saturation of 92% or higher is a good prognostic indicator in Covid patients.

Patients in the treatment arm received 200mg of hydroxychloroquine twice daily for five days.

Relative to controls, time to resolution of fever and cough was about a day shorter in the treatment arm than the control arm, which is encouraging but not dramatic. Nobody in the treatment arm progressed to severe illness vs 13% in the control arm. CT scans between the day prior to study entry and day 6 improved in a higher proportion of treated patients than in controls.

 

Copied post
No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection
https://www.sciencedirect.com/science/article/pii/S0399077X20300858

 

It looks like one trial from China says there is benefit, and the other one Andy posted says there isn’t any? Is it because it possibly only helps mild patients? Or that it works alone better, than it works in combination with the other drug? Or that the sample size for the Chinese trial was too small? Andy do you know the sizes of the severe trial you posted - is it bigger than that of the other trial?

 

This post as been moved from this thread.

https://twitter.com/user/status/1246523470516817923

 

The type of balanced analysis contained in this thread is what we come to Science for ME for. Kudos to @minimus for critiquing this study before many many other people did. Here is one of the first critical reports that I saw on Twitter from Elizabeth Bik on March 21, two days after @minimus
https://twitter.com/user/status/1241429544847863808


Who then wrote this article on March 25
https://scienceintegritydigest.com/...zithromycin-treatment-of-covid-19-infections/

 

I liked the "Brave maverick doctors are not all quacks, but all quacks are Brave Maverick Doctors." since it is a truer example of how numbers work than we get from the Brave Maverick Doctors treating ME.

 

No Hydroxychloroquine Benefit in Small, Randomized COVID-19 Trial
Marcia Frellick

April 16, 2020

"Hydroxychloroquine (HCQ) does not help clear the SARS-CoV-2 virus or relieve symptoms for COVID-19 patients more than standard care alone and has more side effects, a randomized controlled trial of 150 hospitalized adults in China suggests."

requires registration to view full article
https://www.medscape.com/viewarticle/928798?src=soc_tw_share

 

My dad sent me this video tonight. Hmmm?

It's not a video you really have to watch in it's entirety, he just goes over one by one a number of the Covid-19 Hydroxychloroquine studies that have come out and he critiques their methodologies. In addition he argues that the drug is not being given until patients are already in too severe of condition and that it isn't being given with zinc (is there evidence it should be?). He ultimately comes to the conclusion at the end that all the studies coming out are 'shoddy' and poses this against the supposed observation that the drug seems to be working in places such as France, Costa Rica, New York, etc.

The hydroxychloroquine saga has become quite the debate. Am I correct in thinking @Jonathan Edwards remain skeptical of it's use for Covid-19?

https://www.youtube.com/watch?v=dLSYRqcg0wo