First hydroxychloroquine randomized controlled trial: results disappointing

For people that didn&#x27;t read: it&#x27;s &quot;disappointing&quot; because both the control and study groups largely tested negative (93% and 87% respectively). That 87% figure sounds worse than the control but it actually is better than in the French study.<p>What happened in essence is that almost all cases were mild so the patients almost all got better after a while, with or without medication. This doesn&#x27;t mean HCQ is ineffective, only that its efficacy couldn&#x27;t be measured in this instance. And I wouldn&#x27;t call a study where almost everyone gets better at the end &quot;disappointing&quot;.

Why are we amplifying someone posting a compressed jpeg to 3,000 followers who lists no name, has a photo of George Costanza, and claims to be a virologist?

It is a 30 patients test and almost everybody’s fever was gone right after enrollment. Even the swab test results turned negative in 2-4 days. Why is medicine ever needed for such group of patients?

I am sorry, but isn&#x27;t the mechanism of action that hydroxychloroquine is simply a zinc ionophore, i.e. you need enough free zinc in the blood for this to work? I read doctors suggesting using hydroxychloroquine along with 50mg of ionic zinc.

Has anyone found the study they&#x27;re talking about? This tweet is only a screenshot of the abstract.<p>And the trials registry entry says &quot;No results published&quot;: <a href="https:&#x2F;&#x2F;clinicaltrials.gov&#x2F;ct2&#x2F;show&#x2F;NCT04261517" rel="nofollow">https:&#x2F;&#x2F;clinicaltrials.gov&#x2F;ct2&#x2F;show&#x2F;NCT04261517</a><p>Update: I asked the person on twitter and here it is: <a href="http:&#x2F;&#x2F;subject.med.wanfangdata.com.cn&#x2F;UpLoad&#x2F;Files&#x2F;202003&#x2F;43f8625d4dc74e42bbcf24795de1c77c.pdf" rel="nofollow">http:&#x2F;&#x2F;subject.med.wanfangdata.com.cn&#x2F;UpLoad&#x2F;Files&#x2F;202003&#x2F;43...</a> Apparently it&#x27;s in chinese.

didnt find a link to the abstract, seems the results are just being published<p>link to the trial on clinicaltrials.gov is here: <a href="https:&#x2F;&#x2F;clinicaltrials.gov&#x2F;ct2&#x2F;show&#x2F;NCT04261517" rel="nofollow">https:&#x2F;&#x2F;clinicaltrials.gov&#x2F;ct2&#x2F;show&#x2F;NCT04261517</a><p>patients in both tx and control arm fared better than in the french study from earlier this week, suggesting patients were healthier &#x2F; lower risk at baseline<p>patients got slightly lower dose in this study (400 mg &#x2F; day) vs the french study (600 mg &#x2F; day)

Here is actual publication: <a href="http:&#x2F;&#x2F;www.zjujournals.com&#x2F;med&#x2F;EN&#x2F;10.3785&#x2F;j.issn.1008-9292.2020.03.03" rel="nofollow">http:&#x2F;&#x2F;www.zjujournals.com&#x2F;med&#x2F;EN&#x2F;10.3785&#x2F;j.issn.1008-9292.2...</a>

&gt; That was a first run trial without the Zpak. The following trial with both showed 100% efficacy after 5-6 days.<p>Is that twitter reply accurate?

In late January 2020 during the 2019–20 coronavirus outbreak, Chinese medical researchers stated that exploratory research into chloroquine and two other medications, remdesivir and lopinavir&#x2F;ritonavir, seemed to have &quot;fairly good inhibitory effects&quot; on the SARS-CoV-2 virus, which is the virus that causes COVID-19. Requests to start clinical testing were submitted.[43] Chloroquine had been also proposed as a treatment for SARS, with in vitro tests inhibiting the SARS-CoV virus.[44][45] However, at least one case of self-medication with chloroquine for COVID-19 has caused a fatality, and the Nigeria Centre for Disease Control has stated that such self-medication &quot;will cause harm and can lead to death.&quot;<p>Chloroquine has been recommended by Chinese, South Korean and Italian health authorities for the treatment of COVID-19.[47][48] These agencies noted contraindications for people with heart disease or diabetes.[49] Both chloroquine and hydroxychloroquine were shown to inhibit SARS-CoV-2 in vitro, but a further study concluded that hydroxychloroquine was more potent than chloroquine, with a more tolerable safety profile.[50] Preliminary results from a trial suggested that chloroquine is effective and safe in COVID-19 pneumonia, &quot;improving lung imaging findings, promoting a virus-negative conversion, and shortening the disease course.&quot;[51] Self-medication with chloroquine has caused one known fatality.<p><a href="https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Chloroquine#COVID-19" rel="nofollow">https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Chloroquine#COVID-19</a>

Thank goodness that we are actually getting some RCT results. There has been a huge confirmation bias towards any positive results for chloroquine, no matter how specious or flawed the underlying science was. Everybody wants this to work because the drug is well-tested on humans, cheap, and broadly available. It would be a panacea, a miracle drug. My concern is that the desire for this drug to be effective has clouded people&#x27;s judgment (even seasoned researchers) and led to bad science.

It&#x27;s two samples of 15. 13&#x2F;15 and 14&#x2F;15 successes. Much too small to draw any conclusions. It&#x27;s even noted a larger sample size is needed

Wait. I thought that hydroxychloroquine was hypothesized to protect against wet lung, as an anti-inflammatory, and not as an antiviral.<p>Did I just make that up?

Not unexpected. A week or two ago a Chinese treatment protocol made the rounds where hydroxychloroquine was suggested as an alternative to HIV protease inhibitors. Since we now know that ritonavir&#x2F;lopinavir doesn&#x27;t work well, one wouldn&#x27;t expect hydroxychloroquine to do any better. If it had remarkable clinical effects <i>it</i> would be the first-line treatment.

This is evidence; it isn&#x27;t great but it also isn&#x27;t conclusive. We&#x27;ll need to wait longer for something a little more decisive. A twitter link is also unhelpful because we only get a blurry abstract to go off.<p>The happy dream is maybe hydroxychloroquine has prophylactic tendencies since it is something people can take long term to be at a substantially lower risk vs catching COVID. The abstract doesn&#x27;t really show much either way on that front.<p>Spitballing as an amateur, I suspect once someone has actual symptoms or is verging on a serious case it is too late to help - what is a drug supposed to do, regrow a busted lung? It comes to a point where the virus isn&#x27;t what is killing you, it is the damage the virus did while breeding and&#x2F;or the immune system overreacting fighting back and going haywire. Antivirals should help but aren&#x27;t expected to be magic for either of those things.

It seems like the study was conducted on the complete wrong set of patients.

The reported dosage is less than half what the Chinese Government recommends (500mg x 2 (BID)). So it&#x27;s possible that they didn&#x27;t hit the effective dose. <a href="https:&#x2F;&#x2F;medium.com&#x2F;@balajis&#x2F;the-official-chinese-government-guide-to-diagnosing-and-treating-the-novel-coronavirus-9d06868f8df4" rel="nofollow">https:&#x2F;&#x2F;medium.com&#x2F;@balajis&#x2F;the-official-chinese-government-...</a>