Chloroquine trial halted after 11 patients die on high dose

https://www.youtube.com/watch?v=CHZ8wx6J36Q

That's one of the biggest issues with talking up miracle cures. Since it's not been proven, no one is gonna actually put their money behind drastically increasing production (pharma companies, etc. are not gonna put tens of millions of dollars on manufacturing a hunch), but the run on the existing supply means that a lot of people who actually benefited from it (for whom that existing supply was intended) now dont have access to it.

It's a complete lose lose. Even the hoarders don't benefit if it turns out to be beneficial because if it does turn out to be beneficial, production will be ramped up extremely quickly (since it's a known product and process with know side effects, etc...)

edit: To clarify I do not mean to suggest that Trump profited financially like the fictional character in the movie, but rather Trump benefited by being able to tout a potential cure. Ie. Trump profited politically.

> However, higher dose use of chloroquine (600 milligrams as opposed to 450 milligrams) was stopped after just six days, after 11 of patients who were given the greater dose died.

To me that reads as an increase of about 1.35x rather than 4x.

I don't know how people who have no medical training or experience who are actively trying to undermine their advisors with such experience determine which of these medicines they're going to place their bets on, but given the lack of good results in either, it seems like either bet is as bad as the other.

Source: https://www.medrxiv.org/content/10.1101/2020.04.10.20060699v...

Discussion: https://news.ycombinator.com/item?id=22879361

This is why the larger scale trials are necessary, and doctors should be extremely cautious in using any of these drugs unless the covid-19 trajectory looks to be trending towards death anyway. Outside of studies, they should probably not be prescribed for low or medium severity cases.

*Foot note: I'm not a doctor or medical professional. I'm well informed on these matters, but a little knowledge is dangerous. Take the above in that context.

Hydroxychloroquine has fewer side effects than chloroquine which has fewer side effects than quinine which has fewer side effects than the bark it's made from that contains a bunch of other compounds including quinidine.

All quinine class drugs produce heart arrhythmia as a side effect in some patients, more so with increasing doses, and all come with warnings that they should not be used or should be used with caution in patients with heart conditions. These contraindications of these widely used drugs have been known for decades.

(The city is on fire! Those hacks at the fire department failed to predict the earthquake! Fire them all!)

For all we know, it was a successful placebo. Anecdotal evidence does not constitute scientific fact.

Can you elaborate?

I've always heard that it's unethetical to use unproven treatments and that the scientific method (rndm double-blind) was necessary to remove as much bias as possible.

Now such strict requirements obviously don't jam well with fighting on the front line of medicine.

I'm very interested to learn what "less deadly and more informative" ad hoc studies are in this context. (genuine, there is no irony in this comment, this is not my domain)

For starters, to call a compound "reactive" means it's eager to participate in chemical reactions. I'm unable to discern what you were trying to say, but I'm betting it isn't that.

To continue, yes, at the limit, a sufficient dose of anything will kill you. The difference between the therapeutic dose and the lethal dose is referred to as the therapeutic index: wide is good, narrow is dangerous.

(hydroxy)chloroquine has a fairly narrow therapeutic index at the doses being tested for acute COVID-19 intervention. That's not a property you want in a medicine. It would have to be that much more effective to make up for the risk it poses to the patient.

You can construct scenarios where LD50 of water is relevant, say, but it isn't easy to see them in practice I imagine.

"The similar drugs chloroquine and hydroxychloroquine have been pushed by Trump as a possible partial solution to the pandemic..."

[Folks, the point is not about Trump here. The point is that the article's author clearly knows that CQ and HCQ are separate but related drugs].

In-vitro results are worth following up on, but it is my understanding (as a non-expert) that it's very common that they don't pan out in actual humans. Turns out that human bodies and the way we interact with drugs are rather more complex than simple in-vitro situations.

It's really to soon to recommend either drug. Even with 0 side-effects there is a high risk of it being a massive waste of resources better spent elsewhere. This is just classic Trump afraid of being seen as not being on the top of the world in literally every situation.

> I also note that the half-maximal effective concentration (EC50) for blocking viral replication in vitro was 1.13 μM and the half-cytotoxic concentration (CC50) was greater than 100 μM. These are high concentrations for a drug, especially the CC50.

Lots of things work in vitro. Many things don't work when pumped into bodies.

I did notice that. There were articles and some research before and everyone seemed interested and noticed as soon as he mentioned it the majority opinion almost immediately switched to "it's dangerous", "let's avoid it", "it probably won't work" while all the other alternatives seem to be still "interesting" and "worth studying" etc.

The article is describing a trial in Brazil, not the US.

Also, the trial used chloroquine, not hydroxychloroquine. They're not the same.