A new study came out last night in the Lancet which is being used to call for the end of doctors using Choloroquine and Hydroxychloroquine to treat Covid patients without them being enrolled in a clinical trial. Some of the claims about “no chance of any benefit” seem a bit premature given the limits of this kind of study:
Superficially, it looks large and comprehensive but there are three obvious problems with it —
1. It ignores zinc entirely. There is not even a mention of the essential mineral, despite Chloroquine being a well known zinc ionophone (something that pumps a mineral across a cell membrane) and intracellular zinc being identified as a useful anti-viral.
2. It’s not randomized. If doctors are prescribing these drugs to sicker patients or patients with a certain (unknown) genetic risk factor that selection bias (there we go again) could neutralize the entire result. We just don’t know.
3. These were sick people. The total mortality in this whole group was almost 12%. This trial tells us nothing about using these drugs as preventative measures in mild or moderate cases. It doesn’t tell us whether people had symptoms for a week before getting to hospital — and presumably if people saw a doctor early on, used HCQ and zinc, and then didn’t go to hospital at all (because they recovered) then they won’t be counted at all.
So this trial successfully filters and removes the success stories (whatever they are) from early HCQ treatment.
Even Donald Trump knows that HCQ is meant to be used with Zinc, so it is surprising that the medical researchers did not even mention it. Or in this politicized new world of medicine, perhaps it isn’t?
They obtained data from 671 hospitals in many countries and control for obvious factors, and a stack of co-morbidities and demographics. Two thirds of the patients are from the US. They only include patients that are diagnosed, and start one or the other chloroquine type drug within 48 hours of diagnosis (but that may be quite some time after they first got sick). The groups are split into HCQ, or CQ, paired with or without Azithromycin (Az). But both the antimalarial and the antibiotic are known to affect something called the QT interval. Obviously patients who have long QT’s or heart arrhythmia would be at higher risk. Docs would know.
We note that HCQ is not a big money-spinner for large pharmaceutical companies, being an old cheap out-of-patent drug, and that some of these authors do work sometimes with Big Pharma:
Authors Declaration of interests
Doctors seem unimpressed
If comments under the Medpage version of this story are any gauge, it suggests many doctors in the US are unmoved by this study, or are even cynically disillusioned.
Vincent Tedone MD
This article is like rowing a boat with a pool cue.
HCQ + Zn use is indicated only in early cases or as a prophylactic.
Big Pharma influence is all over this.
Robert Dunn
Why they continue to promote these studies which have nothing to do with the proper use of HCQ in helping Covid-19 patients in incredible.
Until they do a study which addresses the use of HCQ in the early/mid stage of the infection, PRIOR to hospitalization, these studies do nothing to clear the air or the virus.
There simply is way too much evidence of doctor/patient treatments that have had dramatic cures of the progression of the disease to have gone this far in time without a definitive and trustworthy analysis of the proper use of HCQ in fighting Covid-19.
Iggy Dalrymple
Hydroxychloroquine has 2 major defects:
1- Trump touted it.
2- HCQ is off patent.
Retrospective studies are ideal for agenda driven “researchers” because they allow cherry-picking the data.
Samuel Rivera
Another garbage, politically motivated study that does not answer the question we physicians want to know. Is HCQ alone or in combination treatment effective prophylaxis or early treatment for COVID 19? All these “analyses” of very sick folks LATE IN THE COVID game are clearly biased against HCQ from the start based on what we know are the mechanisms by which HCQ might help. The attempt to sabotage science is the most disgusting thing I have witnessed in my entire medical career and I am saddened that even physicians have taken sides. By the way, when they talk about more arrhythmias, I want to know exactly what they are talking about- is it more PAC’s, PVC’s. What I really want to know is the incidence of sustained VT or V-fib and whether these arrythmias had any clinical impact at all. The degree of biased interpretation is also very sad!
Obviously, we still need good studies on these drugs to be sure of anything. If Hydroxycholoroquine is useful in a preventative way, we should already see that effect in countries and groups who use it regularly — like Lupus patients or people with Rheumatoid arthritis or who live in malaria-zones. It seems strange there isn’t more information on that available, but perhaps some readers here have seen some?
But most of all, we need to depoliticize medical research somehow…
REFERENCES
Mehra MR, et al “Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis” Lancet 2020; DOI: 10.1016/S0140-6736(20)31180-6.
https://www.thelancet.com/lancet/article/s0140673620311806