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Comment by barbegal | Hacker News Reader

More detailed results on this trial are coming soon but the preliminary results can be found at https://www.recoverytrial.net/results

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This is quite big as a result, although it was done against standard of care (so it can mean a lot of things), because it improves survival.

This brings the list of currently effective pharmacological treatments to two:

- remedisivir (reduces hospital stay, might improve survival)

- dexamethasone (improves survival if requiring oxygen)

Now that the "hydroxychloroquine is dangerous" research has been retracted, does HCQ count as a 3rd treatment? Or did we never get confirmation that it was effective?

Edit: what's with the downvotes? Go look at my post history, I'm not some Russian astroturfing bot. And I got a lot of informative replies, which is why I asked in the first place.

I don't recall seeing anything about it being effective/ineffective as a treatment, only that one study that it doesn't prevent the disease.

we have multiple independent confirmations that it is ineffective against SARS-CoV-2. ( e.g., https://www.recoverytrial.net/files/hcq-recovery-statement-0... , https://www.fda.gov/media/138945/download)

it has known nontrivial side effects, but the study showing measurable harm was retracted.

Also, the study being retracted does not mean it does not cause harm. It just means we don’t have evidence for that at the moment.

It's not even clear that we don't have evidence. The study was retracted because the authors did not want to provide more details on where/how they obtained their data. Probably because they were contractually obligated not to use the data in the way that they did (they made some vague statements to that effect).

You might be interested in this article that tries to explain what happened - from my perspective it was nothing short of a scandal.

https://www.theguardian.com/world/2020/jun/03/covid-19-surgi...

Others studies by one of the authors (Sapan Desai) whose company Surgisphere is supposed to be behind the alleged fraud are being scrutinised and even his credentials are under question now - https://www.theguardian.com/world/2020/jun/10/surgisphere-sa...

i’d trust RetractionWatch here, which also has good coverage.

The same group that conducted this Dexmathasone study concluded that hydroxychloroquine is ineffective: https://www.recoverytrial.net/files/hcq-recovery-statement-0...

"These data convincingly rule out any meaningful mortality benefit of hydroxychloroquine in patients hospitalised with COVID-19."

Note this is not the same group or dataset as the discredited study.

If they were indeed giving deadly doses of the drug by accident, it’s no wonder they stopped the study cold turkey.

That statement is not correct because it does not take into account the pharmacokinetics of the drug.

See the discussion here[1] (from the person who wrote the open letter to Lancet on the now-retracted HCQ study).

[1] https://twitter.com/jwato_watson/status/1272734274823663616

That’s a helpful link. Thx. Looks like no fatal doses.

But I wasn’t claiming they were doing so. I said “if” intentionally, since I know nothing about it.

To be even more precise, ineffective in hospitalized patients. UMN has done another study for "outpatient" (that is, not hospitalized) treatment and sent the results for review.

I'm not expecting any different results than from this one, but we'll know soon enough.

The RECOVERY study is also studying azithromycin, a drug commonly administered with HCQ when used against this disease. It would be ironic if that one proves to be effective (study is still ongoing).

I have been following both the UMN study and this Recovery Trial. I realize, in between whether HCQ prevents SARS-CoV2 and whether the same helps severe hospitalized cases, we have another question of whether it works as early treatment. The first question seem to have been well answered by Dr Boulware's team. The third one seem to also have been definitively been answered by the Recovery team. However, as yet, other than people taking sides in what has now become something of a religious war, I am yet to come across a study that definitively answers this question of whether HCQ can work when given as early treatment. Most of the Covid-19 related literature that is so far accessible seem to be of a very poor quality. But, still, I am hoping we will have properly conducted and sufficiently powered randomized control trials in due course that should answer most of these questions as well as find out a good way out of this quagmire.

Also been done to some extent: https://blogs.sciencemag.org/pipeline/archives/2020/06/04/hy...

That study shows nothing. I assume there'll be others along in time.

It was only ever a con, perpetrated by corrupt politicians.

Are you referring to the retracted Lancet study or the just-breaking-news about the Oxford Recovery Trial where they were using lethal dosages of the drug? [1]

[1] http://covexit.com/recovery-covid-19-research-blasted-for-to...

This seems to be the response to every trial that shows chloroquine and friends to be ineffective, though. "Well, of course there was no positive effect, the dose was too low." "Well, of course there was no positive effect, the dose was too high". "Well, of course there was no positive effect, you didn't tape a halibut to the patient's head". "No, not a cooked one, you fools, a live one!"

At a certain point, it's possibly worth considering that there may be no there there.

I've noticed on Derek Lowe's blog that there seems to be a definite hydroxychloroquine brigade that doesn't exist for any other purported therapy. And as you noticed, this brigade will pick apart HCQ studies for not doing X for a bajillion different varieties of X. (Not simultaneously dosing with zinc and/or azithromycin is the one that tends to be mocked the hardest on the blogs).

Here is a preprint that shows HCQ plus Zinc is effective. My knowledge on this matter comes only from watching a few YouTube videos. From that it has seemed all along that the treatment required is HCQ + Zinc. Zinc is what stops viral replication and HCQ helps get Zinc into the cells. So why are so many trials not using Zinc.

https://www.medrxiv.org/content/10.1101/2020.05.02.20080036v...

Before any of the studies came out, I was reading anecdotes specifically stating, "this only works with zinc". Which is not that hard to believe, from a biochemical perspective.

Apparently most or all of the studies do not include zinc. Hooray.

There may actually be a study which says what you claim, but what you've linked is a HCQ shill site, and tracing links I was not able to find a link to an actual study.

Again, there may actually be a study which says what you've claimed. I'm not anti-HCQ, I'm anti-propaganda-posing-as-science.

I was referring to the Lancet study that was based on suspicious data.

Just for the context, the author of the blog you're linking to is @jpkiekens and here's the kind of things he retweets : https://twitter.com/Covid19Critical/status/12724936329359196...

That seems like a very unreliable source. The author's credentials are "Oxford graduate" and "university lecturer".

The same trial found hydroxychloroquine not to be effective, and patients are no longer being enrolled in that arm of the trial: https://www.recoverytrial.net/files/hcq-recovery-statement-0...

I'd not start dropping HCQ like candy. Beyond the retracted COVID study, it is established that there are risks associated with HCQ usage. use can lead to cardiomyopathy, prolong QT interval and trigger arrhythmia. source: drop chloroquine cardiomyopathy into pubmed or google scholar.

There's quite a spectrum between "HCQ is dangerous and ineffective for Covid-19" and "drink fish tank cleaner".

I agree with you that "dangerous" isn't binary. To be clear, the medical literature I was referencing are focused on medical grade HCQ. I apologize that I was glib in my "like candy" comment. I'm reacting strongly to this topic because the current level of pop-culture medical expertise, partiuclary around HCQ and also vaccines, is concerning to me.

We've been dosing people with hydroxychloroquine for malaria for years so it would be very surprising if it suddenly turned dangerous. It's pretty clear at this point from a number of randomized trials that giving it to people who have developed Covid-19 isn't particularly useful. It's still possible that it might be useful prophylacticly, there's been some promising non-RCT studies coming out of India and at least one RCT underway, but I'm not sure I'd bet on it.

EDIT: And to be clear the Indian studies suggested you wanted to be taking it for weeks before first exposure to SARS-2.

It's always dangerous. It has a black box warning for arrhythmia.

> it would be very surprising if it suddenly turned dangerous

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/00...

Just because something is a useful medicine that's been given for a while doesn't mean it can't also have serious side effects, some of which could conceivably exacerbate Sars-CoV-2.

Or not, there's no evidence that it does. But a lot of medicines are "dangerous", including Plaquenil, particularly if applied for the wrong circumstance or given to people with contraindications.

> Or did we never get confirmation that it was effective?

The reverse, there's confirmation it's ineffective. It may not be dangerous (I don't know) but it's no longer allowed as treatment in the US as the evidence has shown it's not useful.

Can we stop talking about this and move on yet? It was only ever really of interest because Trump was flailing about for anything to make it look like he had a plan earlier in the year.

No, there was interest because this was used in South Korea. Then, trump said a thing, everyone lost their minds, studies were rushed, the press lied about intermediate statistically-insignificant results, and it was a complete embarrassment to the medical community. The politicization of a medicine has been one of the stupidest things I’ve ever seen in my lifetime.

> The politicization of a medicine has been one of the stupidest things I’ve ever seen in my lifetime.

Couldn't agree more. It's insane that medical science gets turned into a partisan pissing match.

> The politicization of a medicine has been one of the stupidest things I’ve ever seen in my lifetime.

This seems to have been going on since Wakefield and the anti-vaxers; and one of the big reasons for rejecting chloroquine was exactly that it was being promoted by a whole infrastructure of dodgy quack websites. Which is undoubtedly where Trump got the idea from.

It may not be dangerous (I don't know) but it's no longer allowed as treatment in the US

This is not true. It is still allowed as a treatment, and there are still studies going on using it in the US. The FDA emergency approval has been removed, which is more of a technical status. You can no longer acquire it from the government stockpile, and it is no longer recommended.

Fair enough, as a non-American I presumed the withdrawal of approval meant something stronger than a recommendation.

Regardless, the point stands, evidence of efficacy is lacking, evidence of lack of efficacy appears to be coming in, this whole thing has turned into a political canard and is likely distracting from real progress.

We never got confirmation that it was effective.

All the early studies that indicated some effectiveness were basically garbage. The french study that caused most hype was flawed in multiple ways. The fact that a study showing its ineffectiveness was retracted is not evidence of the opposite.

Chloroquine (not hydroxy, good old chloro) is used in Central Asia. Death rate is pretty low (less than 10 per million), if you trust official media source of the countries in the region.

There was more than one study that found HCQ dangerous. None had a clear effect.

AFAIK, at this point we can't tell if it has a very tiny positive effect or a small damaging one. None are good news, so why push it further?

> For patients on ventilators, it cut the risk of death from 40% to 28%. For patients needing oxygen, it cut the risk of death from 25% to 20%.

But I would guess that the survival rate for patients who don't require oxygen must be pretty damn high to start with.

From the released statement:

> Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).

I wonder what 13% of people are dying from with COVID if it isn’t SARS...

Ive heard its heart attack.

Most likely this. Low blood oxygen stresses the cardiovascular system so there are greater odds that anything that can go wrong there will.

Cytokine storm syndrome

https://www.sciencedaily.com/releases/2020/05/200513081810.h...

This, as well as Disseminated Intravascular Coagulation(DIC).

https://en.wikipedia.org/wiki/Disseminated_intravascular_coa...

https://emcrit.org/ibcc/covid19/#disseminated_intravascular_...

Two other treatments with results

- low dose of blood thinner (also significant improvement and widely available)

- IL-6 inhibitor tocilizumab (some improvement in severe cases but expensive and hard to scale up)

Both dexamethasone and tocilizumab weaken the immune system. Helps against the overshooting but risks other infections.

Do you have some links to news about these?

If you want to follow Reddit r/COVID19 is regularly posting preprints and has quite a number of professionals in the comments.

I've seen small observational studies with positive results about other IL-6 and TNF-a inhibitors, like Remicade.

I have a particular interest in this because of Crohn's Disease - might the disease be making me high risk, and might my treatment (Entyvio, which operates differently from Remicade and its kin) help offset that anyway?

> it was done against standard of care (so it can mean a lot of things)

This looks like a technical phrase, and the parenthesis suggests that its meaning or implications should maybe be obvious, but they aren't to me! Do you mind elaborating?

"Standard of care" basically means "whatever the current protocol to treat the disease is" (normally it means "the accepted treatment", but there isn't one yet), which can mean just trying to keep the fever down, supplementation of fluids, but also administration of drugs (with the exception of the one tested, of course).

As you can imagine, it is quite variable in what it means, because it varies across countries and occasionally even hospitals (I'm sure the RECOVERY people have taken this into account, though).

It is different from a placebo study because in that case your control is something you know is inert and "does nothing".

Thank you!

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