Will The Data Finally Kill The Treatment Zombie?

ControlsReallyDo

StillMatterVille

From Derek Lowe's latest, titled: Hydroxychloroquine: Enough Already?

At this point, it’s getting hard to see how the idea of a hydroxychloroquine (or hydroxychloroquine/azithromycin) therapy for coronavirus infection can be taken seriously....

First there is this:

...I reviewed some of the recent studies here, but missed a May 11 preprint from France that had claimed benefit for the combination. No matter, though: this was just withdrawn by the authors, who say that they are revising the manuscript...


And then there is this:

...This morning brings this paper from The Lancet. It’s a retrospective look at registered patients across 671 hospitals around the world, and it covers four patient groups: treatment with chloroquine, chloroquine plus a macrolide antibiotic (azithromycin, doxycycline), hydroxychloroquine, or hydroxychloroquine with a macrolide. All of these patients were started on these treatment regimens within 48 hours of diagnosis. The study specifically excludes those patients whose treatment started later, anyone whose therapy was started while they were on mechanical ventilation, or anyone received remdesivir as well. Early treatment in less severe patients only, in other words...


That last part is important, because a concern with some of the earlier studies that showed a lack of efficacy was that the treatments were started too late in the course of the disease

But what about sample size, cohorts, and confounding variables?

...96,032 patients were registered in these hospitals with the coronavirus during the study period (December 20, 2019 to April 14, 2020); this is a large data set. The mean age of the patients was just under 54 years, 54/46 male/female. 14,888 of them were in the treatment sets defined above: 1868 got straight chloroquine, 3783 got chloroquine with a macrolide, 3016 received hydroxychloroquine by itself, and another 6221 got HCQ with a macrolide). That leaves 81,144 patients as a control group getting other standard of care. Let’s note at the start that the authors controlled for a number of confounding factors (such as age, sex, race or ethnicity, body-mass index, cardiovascular disease and risk factors, diabetes, lung disease, smoking, immunosuppressed condition, and overall disease severity)...

Clearly, solid on those fronts. 

So, outcomes?

...The mortality in the control group was 9.3%. The mortality in the chloroquine group was 16.4%. The mortality in the chloroquine plus macrolide group was 22.2%. The mortality in the hydroxychloroquine group was 18%. And the mortality in the hydroxychloroquine plus macrolide group was 23.8%...

And, when you factor in the increases in cardiac arrhythmias, things get even worse for the treatment groups.

Thus, it would appear that, with data like these, this Zombie, errrrr, treatment is likely often contraindicated.

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So, given all that, what will certain non-medical enablers do no now?

My prediction is a double-down on the prophylactic card.

Gosh, I wonder how that will turn out?

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As we have mentioned in the past, Dr. Lowe has both the bona fides and the track record to rigorously assess this stuff.

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