180º Again on HCQ
The WHO and a number of national governments have changed their COVID-19 policies and treatments on the basis of flawed data from a little-known US healthcare analytics company, also calling into question the integrity of key studies published in some of the world’s most prestigious medical journals.
And yet you gotta wonder – you really gotta wonder.
At a minimum, Lancet ought to fire those peer reviewers and never, ever use them again.
Off with their heads. 🙂
There is this apparently pretty solid study just out though, which seems to refute the idea that hydroxychloroquine has an effect: https://www.cbsnews.com/news/hydroxychloroquine-coronavirus-prevention-covid-19-study/. Would be interested in Chris’s take on this one.
Study has issues with mode of recruitment, diagnosis, lack of physician involvement, and patient compliance with the treatment regimen.
I’d call this a pilot study at best. Still hard to know why after so many months we still don’t have a prospective trial for a simple and inexpensive treatment with a 5-day regimen.
To quote the article:
“There are some big caveats: The study enrolled people through the Internet and social media, relying on them to report their own symptoms rather than having them tracked in a formal way by doctors. Participants were not all tested for the coronavirus but were diagnosed as COVID-19 cases based on symptoms in many cases. And not all took their medicines as directed.”
Sounds like the study in question is a load of BS…….
I think the biggest issue with the study was that it was aiming to investigate whether post-exposure HCQ would prevent symptoms. However, starting a post-exposure prophylactic 2-3 days after exposure when the median time to develop symptoms is 5-6 days seems a bit hopeful. I think they either needed to start the regime much more quickly (that is, within 12 hours – admittedly tricky if you need to courier drugs to people across the country) or follow the participants for a longer time to see if the Indian studies bear out and people still develop symptoms but don’t progress to severe disease. Preferably both. Also, decrease the dosing so that people are more compliant with the regime and add zinc, obviously.
What was the recommended HCQ dosage for covid positive people?
600 mg 1st day
then 200 mg daily for seven days? can’t remember it was on one of Chris’s videos but can’t find it any more.
The Boulware HCQ PEP trial was a 1-4 day post-exposure trial. And in fact, there was a benefit, when viewed over that 1-4 day period, but it was relatively minor.
But there is a surprise hidden in the appendix.
If instead of looking at the 1-4 day group, instead you just look at the 1-2 day group, you see a 37% reduction in infections (9.6% vs 15.3%). And if you just look at the 1 day group, it is a 50% reduction in infections. Problem is, there weren’t enough participants at the “1 day” level to be sure.
PEP trials of HIV medications all say – they say it repeatedly – that hours matter. The sooner you take HIV PEP, the more effective it is.
So this pattern we see in Boulware’s PEP trial data is definitely aligned with our experience in other PEP applications. Sooner = better.
The data says: 4 days is just too long. Even 3 days may be too long. The trial should have been 1-2 days. Or may even 1 day. That’s what 10 years of experience with HIV PEP shows. Hours matter. They say this, repeatedly, on the CDC website.
I’d say a possible 50% reduction in cases is a pretty interesting result. It isn’t 100%, certainly, but cutting your chances of dying in half, post-exposure, if you are high risk, would seem to be worthwhile to investigate further. Especially if the cost was on the order of $10.
See page 13, in the appendix to the trial:
How much better would it be if you took it AHEAD of infection? Say, 80%? Like they found in India with their PREP study?